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bZ / <br />STATE OF COLORADO <br />DMSION OF MWERAlS AND GEOLOGY / <br />t 373 Sherman SL, (toot(( 2i s C O L O RA D O <br />Dtlwer CAI0~080203 DIVISION O F <br />Phone (303) 866-3567 ~'Eg 0 9 2006 ~ M I N FORA L S <br />FAx: (3031 63 25 7 06 G E O L O G Y <br />tELLANATtON•MIN INO <br />Diviriaa of Minerals and Gxslogy sAreTV•setervee <br />TRANSFER OF PERMIT AND SIICCESSION OF OPERATORS eel ~^~ <br />APPLICATION FORM awl ~~ <br />Executive Diniaer <br />aaaw w. ~nr <br />DivNiat Direciw <br />Nanml Reouece Trttsntr <br />7lria juror has Gem approved h flu Armed Land Reefareation Bom~d prtrsaant m aedio»a 3¢31-777, C.RS, ajtlee Miwed Land <br />RedmwotiorrAdand 34d1.ZIl7, G1ZS, ojWs ColoradoLandRalmnaafanAdjor tlreEa~adion ojCarstrrr~at Mateadah Any <br />amvadon orneod+ ojthiajorm, xiClwruapprnvalbytheBoard rhaQrtxa6tin theJinmrt#ot ttrarmrrytknrg6sarrl6landrtavrtbr <br />the vaidirrg ajmry perndt icsasd in ewnfrtrseataE rtalalY snch urvaSd frnmFdal ~Innmrry and snbjad the opamor m craae and desist <br />orders and eisdlparaEBesforoperadbrBwikllontopmnhpErrwmitmaerAians34-31-113, GR.S, ajaleMaEedLandRselmnabonAd <br />and34-32.5-]?3, C.R&, oj8ie Coh/rado Land Redmrwllon Ad jar dEe F.abacrian ojCaouovc/6on Materials. <br />The application fa a Transfer of Permit end Stxcession of Operates must contain faa (4) major parts: I) an Application Form; 2) an <br />Application Fm; 3) a Perfartttattac Wecranty (ettachtd m part of the Application Package) bearingtheoriginal /mtatiud signattae of the <br />Stroassor Operator; and, 4) a rephmement Finmtcial Warranty provided by the Successes Operator. bearing an oiigioal Itotarimed sigeanae. <br />To expedite processing, please provide the iDfottttatim is the format and order desLrtbed below. <br />1.Ontlon A: ~ 2 ~0 ~~ ~I wish to WAIVE MY RIGHT to a 30-day protxsvng time to allow the <br />2. <br />AF- O~j~~/l~1 <br />,vov= ~ <br />ot6Le err <br />Muted Lard Reclamation <br />(Initial & Date) Division of Mwetals and Gmlogy to tncalculate the Financial Warranty <br />tequirmaents. lfyal choose Optitm A you shouldg~ submit a Financial Watrgmy <br />and Perfaamance Walrattty tauil the Division ttofifies you of the coma amoutrt of <br />Yea warranty requiremenu.• <br />I DO NOT WISH TO WAIVE MY RIGHT toe 30-day processing time. I <br />(Initial 8c Date) hereby submit a tgllaoemeDt Fina~ia! Warranty for the same dollar amotmt as dte <br />Financial WarraDty Itlainteinod by the ctareat operator. I »odastand that the <br />Division of Mmaals and Geology will recalculate the required reclamation bond <br />within 60-days fry the date that the treader is Lxanpleted and Qx required <br />FINANCLAi. WAR_RANTy COULD BF CI T NTIAi.T y INC FA. ED at <br />that time. As the Crew operator. I agree to be respoDSible for poetin6 8°Y re9~ <br />incaease to the fiaatrcial warraDty for good cause shown, in a form ac:oeptable to the <br />Board, within 60-days of such mice. <br />omLa of <br />Active and tnaetive Mina <br />Cobrado <br />Geobgial Survey <br />