REV10119

• Permit No: M1985211
• IBM Index Class Name: Revision
• Doc Date: 9/1/2000
• Doc Name: TRANSFER OF PERMIT AND SUCCESSION OF OPERATORS APPLICATION FORM
• Type & Sequence: SO1
• Media Type: D
• Archive: No

_~,
II. ADMINISTRATIVE INFORMATION: ~
1. Permit Number: M-1985-211
2. Operation Name:
3. Current Permitted Operator:
Contact Person:
Company Name:
Street:
City.
State:
Area Code.
4. Successor Operator:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
IRS Tar ID No. or Social Security No.:
Berthoud Pink
Tanya Geiser
Neil Sprague
5975 North CountylROad 27
Loveland
CO ZipCbde:80538
970 Telephone: 66 -1920
i
Tanya Geiser
Arkins Park Stone CORPORATION
5975 North County Road 27
Loveland
I
CO Zip Cole: 80538
970 Telephone: 66 -1920

5. Application Fee: $100.00
Make check payable to the Division of Minerals and Gcology ~I
1