REV06400

• Permit No: M1978311
• IBM Index Class Name: Revision
• Doc Date: 3/25/1996
• Doc Name: TRANSFER OF PERMIT AND SUCCESSION OF OPERATORS APPLICATION FORM
• Type & Sequence: SO3
• Media Type: D
• Archive: No

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. ~ ~ 999 ~ 1,AT'~ OF COLORADO
MINED LAND RECLAMATION DIVISION '~~~ .oF.~D~
Department of Natural Resources ~~var °~ _g~~,,r,
t313ShermanSt..ROOm215 QFl,1-~VF~ ~NeiyYlblA-.~
Denver. CO 80203 ~ \~ ~''
303 866-3567 ~ 25~ 19yfi ':;~'
Fa x: 303 632-6106
Roy Rymer.
Division of Minerals 8 Gcu~Dyy ~°°"n°r
Fred R. Banta.
D~~~sion Dirottor
TRANSFER OF PERMIT AND SUCCESSION OF OPERATORS
APPLICATION FORM
The application for a Transfer of Permit and Succession of Operators must contain three
(3) mayor parts: i) an Application Form; 2) a Performance Warranty (attached as part of
the Application Package) bearing the original notarized signature of the Successor
Operator; and, 3) a replacement Financial Warranty (for the amount maintained by the
current permittee) provided by the Successor Operator, bearing an original notarized
signature. To expedite processing, please provide the information in the format and
order described below.
I. ADMINISTRATIVE INFORMATION
1. Permit Number:
2. Operation Name:
3. Current Permitted ODerator:
Contact Person:
Company Name:
Street:
city:
State:
Area Code:
4. Successor Ooerator:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
IRS Tax ID No.
M-78-311
Hawkeye Mine
Perry Flanigan
Ryan Limited
1489 Birch
Montrose
Colorado Zip Code: 81401
970 Telephone: [phone]
Russel L roberts
Blake Mining Company
P.O. Box 783
Nucla
Colorado Zip Code: 81424
970
or Social Security No.:
Telephone: [phone]

5. Application Fee: Si00.00