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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Department of Natural Resources <br /> 1313 Sherman St.,Room 215D O L 0 o N OF <br /> D O <br /> Denver,Colorado 80203 SO-2 RECLAMATION <br /> Phone:(303)866-3567 TJI/THM MINING <br /> FAX:(303)832-8106 SAFETY <br /> APPLICATION FORM <br /> FOR TRANSFER OF MINERAL PERMIT AND <br /> SUCCESSION OF OPERATORS <br /> ADMINISTRATIVE INFORMATION RECEIVED <br /> OCT 1 12024 <br /> Permit Information <br /> Colorado Division of Reclamation, <br /> Permit Number: M2005-069 timing and Safety <br /> Operation Name: West Fork Pit <br /> Permittee Information <br /> Contact Person: Ed Seymour <br /> Company Name: Caerus Piceance LLC <br /> Street Address: 1 001 17th Street, Suite 1600 <br /> city: Denver <br /> State: Colorado Zip: 80202 <br /> Phone: R70 ) 852-9819 <br /> Email (optional): eseymour@caerusoilandgas.com <br /> Prospective Successor Information <br /> Contact Person: Ed Seymour <br /> Company Name: QB Energy Operating, LLC <br /> Street Address: 1 001 17th Street, Suite 1600 <br /> City: Denver <br /> State: Colorado Zip: 80202 <br /> Phone: 070 )852-9819 <br /> Email (optional): eseymour@QB-Energy.com <br /> Office of Office of <br /> Mined Land Reclamation Denver•Grand Junction•Durango Active and <br /> Inactive Mines <br />