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- <br />~. ~.. • <br />~II ~I~~I~~II~~~~~I~ <br />SKATE <br />DIVISION Of MINERALS AND GEOLOGY <br />Department o~ Natural Resources <br />7 }1 J Sherman 51.. Room 215 <br />Denver, CO 80203 <br />Phone: IJOJi d56-15b: <br />F.i%~ i 70}1 83_-N 106 <br />OF COLORADO <br />TRANSFER OF PERMIT AND SUCCESSION OF OPERATORS <br />APPLICATION FORM <br />OF'~~[O <br />ti.* <br />Me' frsII9 ~, <br />• CC~1 <br />rt~o,y . <br />Roy Romer <br />Governor <br />mLChaeI B. LOnR <br />Division Dnector <br />The application for a Transfer of Permit and Succession of Operators must contain four <br />(4) major parts: 1) an Application Form; 2) an Application Fee; 3) a Performance <br />Warranty (attached as part of the Application Package) bearing the original notarized <br />signature of the Successor Operator; and, 4) a replacement Financial Warranty provided <br />by the Successor Operator, bearing an original notarized signature. To expedite <br />processing, please provide the information in the format and order described below. <br />I. ADMINISTRATIVE INFORMATION ~~ ~ ~ D <br />Permit Number: <br />Operation Name: <br />/-1- 81- os~ 111 ~ /,~ <br />Nerl C: S~Jr3grip -L7erG~ot1 Phll sltOgg <br />SPhq~ue - e <br />Current Permitted Operator: <br />Contact Person: or Shrvr~ve' <br />Company Name: ~Prf-~nu~ ~~n S~OVr~ <br />Street: rSg75 ~~~'~ <br />City: lP ~an d CO~a <br />State: Zip Code: fZOS3 ~ <br />Area Code: ~ b3 Telephone: (0(03- / 9';~ <br />Successor Operator: <br />Contact Person: C S r e o r ~wd a <br />Company Name: &rKlns ar~1 .S~olze r/~. <br />Street: S97?S Pte. 12 ~ a7 <br />City : aC 0 U E I cZ h [~ CO ~ U <br />State: Zip Code: g_ o s 3 g <br />Area Code: ,~03 Telephone: loly3-l `r2b <br />i°e~ <br />IRS Tax ID No. or Social Security No.: S~3-ti2- FS324 S`1-ii'7-'Y9/~j <br />Application Fee: 5100.00 Y ~ - ~-,~a•q <br />Make check payable to the Division of Minerals and Geology <br />Nub. - NCB I <br />