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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> IVED <br /> Department of Natural Resources <br /> JUN zQ2z COLOADO <br /> 1313 Sherman St.,Room 215 DIVISION OF <br /> Denver,Colorado 80203 RECLAMATION <br /> MINING <br /> Phone.(303)866-3567 DIVISION OF RECLAMATION —&— <br /> FAX-(303)832-8106 MINING R SAFETY-MINERALS SAFETY <br /> APPLICATION FORM <br /> FOR TRANSFER OF MINERAL PERMIT AND <br /> SUCCESSION OF OPERATORS <br /> SO-2 <br /> ADMINISTRATIVE INFORMATION <br /> CJDIJLE <br /> Permit Information <br /> Permit Number: — <br /> Operation Name: � t <br /> Permittee Information <br /> Contact Person: 1"5 k, �# <br /> Company Name: w Jn k k w6 L _ <br /> Street Address . �n � <br /> City:, <br /> State: - r, : Zip: <br /> Phone: f- 1 <br /> Email (optional): _ <br /> Prospective Successor Information <br /> Contact Person: <br /> Company Name: k j:;, } -4—N IL. <br /> Street Address: I I I � 4e I Al.- ., <br /> City: N - <br /> State: rn Zip: SAD <br /> Phone: 1 <br /> Email (optional): <br /> Office of Office of <br /> Mined Land Reclamation Denver-Grand Junction-Durango Active and <br /> Inactive Mines <br />