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STATE OF COLORADO <br /> DIVISION OF RECLAMATION, MINING AND SAFETY <br /> Department of Natural Resources <br /> COLORADO <br /> 1313 Sherman St,Room 215 D IV IS I ON OF <br /> Denver,Colorado 80203 RECLAMATION <br /> Phone:(303)866-3567 M I&N G <br /> FAX: (303)832-8106 SAFETY <br /> APPLICATION FORM <br /> FOR TRANSFER OF MINERAL PERMIT AND <br /> SUCCESSION OF OPERATORS <br /> ADMINISTRATIVE INFORMATION <br /> Permit Information <br /> Permit Number: p <br /> Operation Name: <br /> Permittee Information <br /> Contact Person: <br /> � I <br /> Company Name: <br /> Street Address: 1 jDLANID <br /> City:_ )06bL T - <br /> State: 00 Zip: <br /> Phone: ) — S <br /> Email (optional): Ivla r1/�ai�.CL+vtti <br /> Prospective Successor Information <br /> Contact Person: 3 Se A� ,L ba,Al S <br /> Company Name: ��/�� •j� /1'!.`rzeo/yt1s , L� <br /> Street Address: 7 L'c�e� A&s �r <br /> City: S4i;,*7 4 S <br /> State: Zip: g 9 e <br /> Phone: (71q ) 6 85 j1Y7 I <br /> Email (optional): ;4nvrIm 5' rw ,'jyera czj4f <br /> Office of Office of <br /> Mined Land Reclamation Denver•Grand Junction•Durango Active and <br /> Inactive Mines <br />