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STATE OF COLORADO <br /> DIVISION OF RECLAMATION, MINING AND SAFETY R E C E I V E n <br /> Department of Natural Resources <br /> FEB0 3 2023 C V I S 1 0 N O <br /> 1313 Sherman St.,Room 215 t v i s i o N o f <br /> Denver,Colorado 80203 RECLAMATION <br /> Phone:(303)866-3567 DIVISION OF RECLAMATION, MINING <br /> FAX:(303)832-8106 MINING &SAFETY-MINERALS SAFETY <br /> APPLICATION FORM <br /> FOR TRANSFER OF MINERAL PERMIT AND <br /> SUCCESSION OF OPERATORS <br /> ADMINISTRATIVE INFORMATION SO-5 <br /> ERR/MAC <br /> Permit Information <br /> Permit Number: M <br /> Operation Name: <br /> Permittee Information <br /> Contact Person: <br /> Company Name: G LC_ <br /> Street Address: <br /> City: y1 Aa, �I•e <br /> State: Z arc_ ;G ,,u Zip: 7enoz�_� <br /> Phone: ( 5vy ) eZ 7 Z <br /> Email (optional): <br /> Prospective Successor Information <br /> Contact Person: Sc ;/ L'� <br /> Company Name: <br /> Street Address: 6 4 7- <br /> Cit <br /> State: Zip: ;9p l vs. <br /> Phone: ( q70 ) 9Gy-6io� <br /> Email (optional): <br /> Office of Office of <br /> Mined Land Reclamation Denver•Grand Junction•Durango Active and <br /> Inactive Mines <br />