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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY RECEIVE <br /> Department of Natural Resources <br /> COLORADO <br /> 1313 Sherman St.,Room 215 D I v I s 10 N OF <br /> Denver,Colorado 80203 JUN 3 0 W3 RECLAMATION <br /> Phone:(303)866-3567 MINING <br /> FAX:(303)832-8106 DIVISION OF RE01,AMATIQN —&— <br /> MINING&SAFETY-MINIMAL <br /> SAFETY <br /> APPLICATION FORM <br /> FOR TRANSFER OF MINERAL PERMIT AND <br /> SUCCESSION OF OPERATORS <br /> ADMINISTRATIVE INFORMATION SO-1 <br /> BFB/MAC <br /> Permit Information <br /> Permit Number: I(�(� a 0 O (o -7 <br /> Operation Name: '� `Z T' rG Q ►(ZT <br /> Permittee Information <br /> Contact Person: 1 �\ &,v-v S K q, S <br /> Company Name: 0, C�.� �' ti Z o O V\ £ , L L- C <br /> Street Address: 14 c1 Co U A- goo'-d <br /> City: P t' �+Clk 40-- `-{- <br /> State: o \0 j'a. GO Zip: �� (G L <br /> 4 <br /> - o <br /> Phone: (j l <br /> Email (optional): C� r ?� 5� ��' �'1 VVl0, <br /> Prospective Successor Information <br /> Contact Person: S <br /> Company Name: c' U 2 2 I .3Q»Gh <br /> Street Address: 13 L9ol� r <br /> City: `6 4 <br /> State: culc Ol I/-, Zip: <br /> Phone: ( *]�(� ) �3 '' --U7/ <br /> Email (optional): e FaeC ry1 Gn r(A'L' rN <br /> Office of Office of <br /> Mined Land Reclamation Denver•Grand Junction•Durango Active and <br /> Inactive Mines <br />