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STATE OF COLORf~DO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Nawral Resources <br />1313 Sherman SL, Room 215 <br />Denver, Colorado 80203 <br />Phone: 1303) 866-3567 <br />FAX: (303) 832-8706 <br />APPLICATION FORM <br />Division of Minerals and Geology <br />~~ <br />DIVISION Or <br />MINERALS <br />GEOLOGY <br />R E~G LAMATION <br />MINING•SAF ETY <br />Bill Owens <br />Governor <br />Greg E Watcher <br />Executive Dvecmr <br />Michael B. Long <br />Division Director <br />The application for a Transfer of Pemrit and Succession of Operators must contain four (4) major parts: I) an Application <br />Form; 2) an Application Fee; 3) a Perfom~ance Warranty (attached as part of the Application Package) bearing the original <br />notarized signature of the Successor Operator; and, 4) a replacement Financial Warranty provided by the Successor <br />Operator, bearing an original notaized signature. To expedite processing, please provide the information in the format _ <br />and order described below. <br />/") I. FINANCIAL WARRANTY INFORMATIO <br />1. ti n A: <br />TRANSFER OF PERMIT AND SUCCESSION OF OPERATORS <br />(Initial & Date) <br />2. Option B: ~~~ <br />(mina] & Date) <br />FiECEI'1fE® <br />AUG 3 02004 <br />Permit #: M-1980-193 Confidential?. N <br />Class: Revision Type/Seq.: SO-2 <br />From: rocky Mountain Materiels & Asphalt, Inc. To: DMG <br />Doc. Name: SO Virgil B, and Lorraine E. Mitchell to Rocky <br />Mountain Materials & Asphalt, Inc. <br />Date: 08/30/2004 <br />Specialist: LDO <br />I wish to WANE MY RIGHT to a 30-day processing time to allow <br />the Division of Minerals and Geology to recalculate the Financial <br />Warranty requirements. Ifyou choose Option A you should not submit <br />a Financial Warranty and Performance Warranty until the Division <br />notifies you of the correct amount of your warranty requirements. <br />I DO NOT WISH TO WANE MY RIGHT to a 30-day processing <br />time. I hereby submit a replacement Financial Warranty for the same <br />dollaz amount as the Financial Warranty maintained by the current <br />operator. I understand that the Division of Minerals and Geology will <br />recalculate the required reclamation bond within 60-days from the date <br />that the transfer is completed and the required FINANCIAL <br />WARRANTY COULD BE SUBSTANTIALLY INCREASED at that <br />time. As the new operator. I agree to be responsible for posting anv <br />required increase to the fv,arcial warranty for good cause shown, in a <br />form acceptable to the Eoard, within 60-days of such notice. <br />NOV = NoN~ <br />A-F = I o~2alo4 <br />