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STATE OF COLORADO <br /> DIVISION OF RECLAMATION, MINING AND SAFETY INJED <br /> Department of Natural Resources RECE. G <br /> A �O�C COLORADO <br /> 1313 Sherman St.,Room 215 11 r� `t J D I V I S I O N OF <br /> Denver,Colorado 80203 JuN L RECLAMATION <br /> Phone:(303)866-3567 RECLAMATION MINING <br /> FAX:(303)832-8106 DIVISION O Y —&— <br /> MINING AND SAFTE SAFETY <br /> APPLICATION FORM <br /> Q FOR TRANSFER OF MINERAL PERMIT AND <br /> �0� SUCCESSION OF OPERATORS <br /> SGP SO-1 <br /> DMC/THM <br /> ADMINISTRATIVE INFORMATION <br /> Permit Information <br /> Permit Number: _A4 _ �ao i/ _ br,,5— <br /> Operation Name: 0 .,(_, <br /> Permittee Information <br /> Contact Person: <br /> Company Name: <br /> Street Address: G3l6a Lc,,Sklcz as <br /> City: �]/lon Frs S t <br /> State: C,alo rao�a Zip: 'd[4 d l <br /> Phone: ( 9 7e, ) �L,5A - 7c oa 3 <br /> Email (optional): alf•��-� !9 r,_4- <br /> Prospective Successor Information <br /> Contact Person: <br /> 1 rt � L/ V•*LY <br /> Company Name: R�,�lL I,cF#o•+� (��s��., c.zs� L,L.c <br /> Street Address: Qv B G x <br /> City:4,1O r We,e. <br /> State: e_G(o r f ej& Z1P: f3l i 23 <br /> Phone:-( q 2e, ) 5 eu - C 7 t <br /> Email (optional): /✓ler ,1f tr �G, w_�'C✓fir w�f rt< P Yk/.00, Go w. <br /> Office of Office of <br /> Mined Land Reclamation Denver•Grand Junction•Durango Active and <br /> Inactive Mines <br />