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<br /> <br />~ STATE ~. COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1 3) J Shrrm~n SL. Room ,1 s <br />Denver, CO P,v_'U1 <br />Plrnne: 1303 ~ a66-3557 <br />r.~z:lJo3~ H3.-al o6 <br />RECEIVED <br />APR 1 ]993 <br />Division of hfinerar< ~P <br />TRANSFER OF PERMIT AND SUCCESSION OF OPERAI`~1R5o1ggy <br />APPLICATION FORM <br />c <br />4~ ~{~ <br />~::` ' <br />' revs <br />RaY Romer <br />Governor <br />MrcFUel B-Long <br />Division DirKror <br />The application for a Transfer of Permit and Succession of Operators must contain three <br />(3) major parts: 1) an Application Form; 2) a Performance Warranty (attached as part of <br />the Application Package) bearing the original notarized signature of the Successor <br />Operator; and, 3) a replacement Financial" Warranty provided by the Successor Operator, <br />bearing an original notarized signature. To expedite processing, please provide the <br />information in the format and order described below. <br />.~a -Gb <br />I. ADMINISTRATIVE INFORMATION <br />1. Permit Number: <br />2. Operation Name: <br />3. Current Permitted Operator: <br />Contact Person: <br />Company Name: <br />Street: <br />City: <br />State: <br />Area Code: <br />4. Successor Operator: <br />Contact Person: <br />Company Name: <br />Street: <br />City: <br />State: <br />Area Code: <br />IRS Tax ID No. <br />CARESTIA PIT <br />r <br />RACPH CARESTIA <br />CARESTIA TRUCKING CO. <br />420 N. MCCANDLESS <br />FLORENCE <br />COLORADO Zip Code: R <br />719 Telephone: 784-3878 <br />DEL RODARMEL <br />FLORENCE SAND E GRAVEL <br />799 NTH STREET <br />PENROSE <br />COLORADO Zip Code: 81240 <br />719 Telephone: 47 -r;n7~ <br />or Social Security No.: -S"a / - ~ ~ - S/ ~ ~~. <br />5. Application Fee: 8100.00 ,/ c <br />Make check payable to the Division of Minerals and Geology +~.~. `~-~~`~ <br />M-81-036 <br />Nv d. ~- N v <br />