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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY �y <br />Department of Natural Resources pECEItt VEV <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 NOV Q 8 2021 <br />Phone: (303) 866-3567 . y <br />FAX: (303) 832-8106 <br />DIVISMINING & SAFETY <br />ION <br />APPLICATION FORM <br />FOR TRANSFER OF MINERAL PERMIT AND <br />SUCCESSION OF OPERATORS <br />ADMINISTRATIVE INFORMATION <br />Permit Information <br />Permit Number: M 1 g q b - - <br />Operation Name: Ir p yL,, t�� <br />Permittee Information <br />Contact Person: c,, aA 6 1E I \ V)n. 0y <br />Company Name: <br />Street Address: <br />City:py� <br />State: C Zip: 8 p S <br />Phone: ( -11q ) 5 V 5� — 1,e1 \.;;l. <br />Email (optional): ytjV% owe` <br />Prospective Successor Information <br />Contact Person: Q Ltk1 - USA r <br />Company Nam( <br />Street Address: <br />City: <br />COLORADO <br />IDIVI S I ON OF <br />RECLAMATION <br />MINING <br />SAFETY <br />SO -4 <br />J PL/J LE/SMS/AWA <br />State: lib 1 Zip: $ -)q S" <br />Phone: I cl ) Sa-Cj - 0 �j l �. <br />Email (optional): .t t--, A ; <br />Office of Office of <br />Mined Land Reclamation Denver • Grand Junction • Durango Active and <br />Inactive Mines <br />