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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 SO-1 o IV I s l ON OF <br /> - <br /> Denver,Colorado 80203 RECLAMATION <br /> Phone:(303)866-3567 NCG/AME MINING <br /> FAX:(303)832-8106 <br /> SAFETY <br /> APPLICATION FORM <br /> FOR TRANSFER OF MINERAL PERMIT AND <br /> SUCCESSION OF OPERATORS <br /> ADMINISTRATIVE INFORMATION RlCrVED <br /> jUR 0 I Z05 <br /> Permit Information a1, <br /> �pbrado Division of RIeC� <br /> Pennit Number: M 1990„ -83 "s)d Sd* <br /> Operation Name: Rother Pit #1 <br /> Permittee Information <br /> Contact Person: Marcy Brossman <br /> Company Name: Cheyenne County <br /> Street Address: PO BOX 567 <br /> City: Cheyenne Wells <br /> State: CO Zip: 80810 <br /> Phone: T1 9 ) 767-5872 <br /> Email(optional): t CoLdf1i+(ice('e e.�-Fee.`1e; <br /> Prospective Successor Informatia <br /> Contact Person: AAVM- t <br /> Company Name: Co Q ;%& I L•LII�' <br /> Street Address:_ ►�. �� _ / �1 eF-� <br /> City: 14~— <br /> State: 4Z' IA4T _ <br /> Phone: <br /> Email(optional): r Iric ttcv . <br /> Office of Office of <br /> Mined Land Reclamation Denver•Grand Junction•Durango Active and <br /> Inactive Mines <br />