REV91774

• Permit No: M1977081
• IBM Index Class Name: Revision
• Doc Date: 5/20/1996
• Doc Name: TRANSFER OF PERMIT AND SUCCESSION OF OPERATORS APPLICATION FORM
• Type & Sequence: SO2
• Media Type: D
• Archive: No

-2-
II
ADMINISTRATIVE INFORMATION:
1. Permit Number:
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 lax ID No.
M-77-081
Greeley West Pit
Julie Goettemoeller
W s.e rn Mtshil TnC_
1590 W, 12th Avenue
Denver
co Zip Code: aozoa
303 Telephone: [phone]
Julie Goettemoeller
Western Mobile Northam .Ino,
1590 W, 12th Avenue
Denver
co Zip Code: aozoa
303 Telephone: 657-x331
or Social Security No.: n
5. Application Fee: 5100.00
Make check payable to the Division oi= Minerals and Geology