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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Department of Natural Resources <br /> 1313 Sherman St.,Room 215 D I I S E I O L ON RA D OF <br /> DV <br /> Denver,Colorado 80203 RECLAMATION <br /> Phone:(303)866-3567 MINING <br /> FAX:(303)832-8106 —&— <br /> SAFETY <br /> APPLICATION FORM <br /> FOR TRANSFER OF MINERAL PERMIT AND <br /> SUCCESSION OF OPERATORS <br /> ADMINISTRATIVE INFORMATION <br /> Permit Information <br /> Permit Number: M-2000-050 <br /> Operation Name: Broken Spear <br /> Permittee Information <br /> Contact Person: Mark Bain <br /> Company Name: Bain Farms LLC <br /> Street Address: 31395 CR 3V <br /> city: Genoa <br /> State: CO Zip: 80818 <br /> Phone: ( 719 ) 740-2363 <br /> Email (optional): <br /> Prospective Successor Information <br /> Contact Person: Fred Lundy <br /> Company Name: Lincoln County <br /> Street Address: 103 3rd Ave PO Box 39 <br /> city: Hugo <br /> State: CO Zip: 80821 <br /> Phone: p19 ) 743-2337 <br /> Email (optional): Iclanduse@lincolncountyco.us <br /> Office of Office of <br /> Mined Land Reclamation Denver-Grand Junction•Durango Active and <br /> Inactive Mines <br />