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P,ECEIVED 'So - I <br /> MAR 0 7 2022 <br /> DIVISION OF RE Y�MINE ION, <br /> MINING&SAFETY MIRAI S <br /> 'STIALTE OF COLORADO <br /> DIv19ION OF RECL4MATION,MINING AND SAFETY <br /> Deperanenr of Natural Reemu,eee <br /> COLO0.A1?O <br /> 1313 8hermpn St.Roan 215 D/V,8,O H Of <br /> Denver.Colorado KMRECLAMATION <br /> Phona-(303)888.3687 &� <br /> FAX:(303)932-8106 LAW <br /> APPLICATION FORM <br /> FOR TRAN�FER OF b RNEJPERMIT AND <br /> SUCCESSION F OPERATORS <br /> AIDMRMTRATIF a IN ORMATION <br /> Permit Information <br /> Permit Number. - rl oo -;- <br /> Operation Name: G 12 t?A <br /> Permittee Information <br /> Contact Person: pl ,C t_ L— 2 04 R S►ov,4-t— fZ W <br /> Company Name: i C 3 t? <br /> Street Address: -7977 W 13 R 0/Z D <br /> City: L f,rr <br /> State: otvfZ 4- ZIP: <br /> Phone: T-�— <br /> Email(optional): 1),i g tz>4 e A./ G•�r�►a e.. ep <br /> Prospective Successor Information <br /> Contact Person: <br /> Company Name: L ,ti d 5 L L L <br /> Street Address: ^1 eL 56 e— f o 0 <br /> City: 'n/r <br /> State: T rr*A KF$ Zip: <br /> Phone 2 14 17-7 <br /> Email(optional): 13 0 S M y Wrf 4,5 G. IV eT, <br /> omoe of Wee of <br /> Mined Land Redemadon Denver•Gran I JwxWn•DurwW Adive and <br /> I mlive Mhaa <br />