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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 I v[stowZ <br /> P <br /> Denver,Colorado 80203 r C TN <br /> Phone:(303)866-3567 T MININ <br /> FAX:(303)832-8106 — <br /> SAFETY <br /> APPLICATION FORM <br /> TRANSFER L IT AND <br /> ` ��� SUCCESSION OPERATORS <br /> Cnl <br /> �1�I1 ADMINISTRATIVE INFORMATION �� E �; <br /> D <br /> OCT '112024 <br /> Permit Information cdomdo i)lsbtt of Relnialloa, <br /> Permit Number: 2O05-069 Wakig and Wety <br /> .......................m....... <br /> Operation game: .. ......... ........ ......... ........ ............. ___.................... <br /> West Fork Pit <br /> Permittee Information <br /> Contact Person: Ed Seymour <br /> ........................._.........................................................______.._..-._-. .................. ........................................................................ <br /> Company Name: Caerus Piceance LLC <br /> .....................................................�. .........................................................._..__................................................................_...._................................._................................................................................_._ ................................ <br /> Street Address: 1001 17th Street, Suite 1600 <br /> ........................................................................................................................................................................................ <br /> City: Denver _....._A.._A.._A.._. .. .............. .................. .......................... <br /> State: Colorado Zip: 0202 <br /> . �N..- ,,.______.____________________________...__ P <br /> Phone $52 9819 <br /> Email (optional): meSey1 OU1 @. aerU_aQi[ 1dga.; .,.COt71, <br /> Prospective Successor Information <br /> Contact Person: Ed Seymour <br /> Company Name: QB�......................� �Energy Operating, LL <br /> .._� sN..._.... <br /> Street Address: 1001 17th Street, Suite 1600 <br /> ........ w.._............................ ___....__. ........ <br /> City: Denver <br /> _�m... _ .............................................. ------mmm.m.m_........................................................m. <br /> state: Colorado Zip: 80202 <br /> Phone: 70852-9819 <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 />