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r ' <br /> STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MININ(3 AND SAFETY <br /> Department of Natural Resources <br /> COLORADO <br /> 1313 Sherman St.,Room 215 SQ_2 �t v�s �o N o F <br /> Denver,Colorado80203 CJD/JLE �MIL N NGON <br /> Phone:(303)866-3567 <br /> FAX:(303)832-8106 SAFETY <br /> APPLICATION FORM <br /> FOR TRANSFER OF MINERAL PERMIT AND <br /> SUCCESSION OF OPERATORS �������� <br /> . , � . , <br /> APR 0�2022 <br /> ADMINISTRATIVE INFORMATION � �'�t� <br /> pIViSIOtNC�F��L�A�I�AATION <br /> MINING 8 SAFETY-MINEi���� <br /> DIVIS�ON vF Rt(,LHwiATION <br /> Permit Information MINING AND�1FETY <br /> Permit Number: (Y1 - �ObU " � � � <br /> Operation Name: S - p + # � <br /> Permittee Information <br /> Contact Person: C- N��` I"Yl v���t-s' <br /> Company Name: � �� <br /> Street Address: u n1 <br /> City: �/1��5-� Cr..� � ��-c <br /> State: (�'r, ZIP: � �_�� <br /> Phone: ( 7 l� ) S s J ^ ,�� � 5, <br /> Email (optional): <br /> Prospective Success Information <br /> Contact Person: n C ' � v�- <br /> Company Name: o � l� C O � <br /> Street Address: i� � �' <br /> C ity: 1—+L A M G S A <br /> State: ('r, Zip: � � (O � <br /> Phone• (`��� ) ��� � �l(�� <br /> Email (optional): �'� �'i c v'�i� �� Cv � �� <br /> Office of Office of <br /> Mined Land Reclamation Denver•Grand Junction•Durango Active and <br /> Inactive Mines <br />