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STATE OF COLOP~ADO <br />DIVISION OF MINERALS AND GEOLOGY <br />DePanment d Natural Resources <br />1313 Sherman Sl, Room 215 <br />Denver, Catorado 80203 <br />PF,o[le: (303) 8663567 <br />FAX: t303) 832A106 <br />APPIdCATION FORM <br />COLORADO <br />D IYISION DF <br />MIN RALS <br />GEOLOGY <br />EECLAMATIeNMIN ING <br />fA,[Tr•3UENCE <br />Bill Coda <br />Governor <br />Russell GerNBe <br />Eaecuase Director <br />Ronald W. Camrry <br />lNvi[ion Dinxtar <br />Ne[unl Raolace T,ugee <br />Tiia jornE has 6ern approved by the Mared Lund RedanEalion Board pwsnant to sections 343?-177, GRS, of the MLred Land <br />RedmnaBossAdand34-32117, CRS, aftkeCoJorado Land RaaimsaOtmaAdjorlkeF.xbacYluosr ojCwcox M~i~ak Auy <br />aloe ornw~reotlorE al~nl~, ~adappraaalbytlieBoardahaflrestrlfbE tlrefuEanciolxvrrantybebrBinEOidmrdnewC6E <br />the vol~ng ajany panEfr i+sned w oouJwutton with sndk invaiidj5rmutio1/1rQlranly and sabled dre opdator to cease and desast <br />orders and dvllparaEJhajar oposa6rgwiNront apanritprrrsaant to reeeiarrs 3~3~113, C.RS, ojdYeMared LmrdRor/mnabonAd <br />and 34-33.5-113, GRS, of tlu Colorado Land Redansolion Adj~ the Eatradion of Constr~sdion Maferialr. <br />The application for a Tran.~'er of Permit and Suoceasion of Operators must ooatain fora (4) major parts: 1) an Application Form; 2) an <br />Applicetien Fee; 3) a Performance Warranty (attached as paR of the Application Package) bearing the original notarized signature of the <br />Suocesvor Operates; and, 4) a replacement Financial Wartanty provided by the Sttcressor Operator. bearing en original sigaatule. <br />To expedite proces~ng, please provide the infeamation in t1x format and order descnbed below. <br />FINANCIAL WARRANTY INFORMATION (Choose ONE ODtion): <br />1. Ootbn A: <br />TRANSFER OF PERMIT AND SIICCESSION OF OPERATORS <br />(Initial & Date) <br />2. Oy onri .$: ! b l s~~~ <br />(Initial R Date) <br />I wish to WAIVE MY RIGHT to a 30-day procesmng time to allow the <br />Divisdam of Mrnasls and Geology to recalculate the Finance! Warranty <br />requi:emmta IfyouchooseOptionAyoushouldgojsubmitaFineacial Wertmlty <br />end Performance Warranty until the Division notifies you of the correct amount of <br />your walranry requiremems•` <br />I pg NOT WISH TO WAIVE MY RIGHT to a 30-day processing time. I <br />heraby submit a replacenxat Finmciel Werrmry for the same dollar emolrnt as die <br />Financial Warranty maintained by the current operator. I tmderstand that the <br />Division of MneraLs and Geology will recalculate the squired reclamation bond <br />within 60-days firm the date that the transfer is oampleted and the r~equirtd <br />F~IANCIAL_W ARBANTY COULD BE SUBSTANTIALLY INCREASID at <br />that time. As the new operator. I egse a be responsible for posting airy required <br />increase to the finenciel warranryfor good csuse shown, in a form acceptable ro the <br />Board, within 60-days of such notice. <br />Offite of Office of Colorado <br />.. . _ . ~,_._ __~ ,_.~:._ u:.... GwJ,wiral Gwev <br />