REV13636

• Permit No: M1997064
• IBM Index Class Name: Revision
• Doc Date: 9/14/1998
• Doc Name: TRANSFER OF PERMIT & SUCCESSION OF OPERATORS APPLICATION FORM
• Type & Sequence: SO1
• Media Type: D
• Archive: No

,_
ADMINISTRATIVE INFORMATION:
I . Permit Number:
2. Operation Name:
M-
Agri-Cal 111
3. Current Permitted Operator:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
4. Successor Ocerator:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
IRS Tax ID No. or Social Security No.:
William Vestal
Western Nutrients. L.L.C.
P.0. Box 731
Canon City
Co Zip Code: 81212
(719) Telephone: [phone]
lJl t_~.I~ 14 IIESiFIL
Western Nutrients, Inc.
P.0. Box 731
Canon City
CO Zip Code: p81212
-~ i 9 Telephone: 789 1~~~
~~7-~G-443/
5. Application Fee: $100.00
Make check payable to the Division of Minerals and Geology