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, I aPR ~s • 9a <br />_j~~~~ <br />7o~saarl nr~'~IraCn~scEC III'II'll'll"II III . • P.a~sJ <br />STATE OF COLORADO <br />OF MINERALS AND GEOLOGY <br />~r or Natural Resources <br />~ I 1713 Sherman Sc. Room 215 <br />Denver, CO 60703 <br />~ Phone: 13U3i dGG•li8? <br />F.1x: ~3U316J 7.8106 <br />P c0 <br />RECEIVED ~~~~ <br />M:" <br />r8 5 ~ <br />APR 29 1993 '~^~~' ~ <br />RoY Ramer <br />GO•'bnOr <br />Division ei M~nera'~s ~ iieoloyy Mlchaal B. LOnp <br />TRANSFER Df P£RMIT AND SUCCESSION OF OPERATORS oi.~s~on 9~recio. <br />APPLICATION FORM <br />hR application for a Transfer of Permit and Successipn of Operators must contain four <br />4) ma3or parts: 1) an Application Form; 2) an Application fee; 3) a Performance <br />arranty (attached as part of the Application Package) bearing the original notarized <br />i9nature of the Successor Operator; and, 4) a replacement Financial Warranty provided <br />y the Successor Operator, bearing an original notarized signature. To expedite <br />rOcessing, please provide the information in the format and order described below. <br />ADMINISTRATIVE INFpRh4ATI0N <br />Permit Number: <br />2. Operation Name: <br />3, Current Permitted Operator: <br />Contact Person; <br />Company Name: <br />Street: <br />City: <br />State: <br />Area Cvde; <br />4. Successor Operator: <br />Contact Person: <br />Company Name: <br />Street; <br />City: <br />State: <br />Area Code: <br />IRS Tax ID No. or Social <br />M-81-loC-S <br /> <br />l~E-s~av+~ -~o~11G A./sr'E-R~,•q ~,rJC <br />pnno Doy ~ )s88 <br />UG W a1 Cr C, O <br />~ © ~ Zip Code: 80eta.1-,27~.~.5' <br />303 Telephone: a2lo- <br /> <br />G~a.~ -E Gros Cc,ns'1' 1.'t'A ~,a6,) fyCo.+a~a~~ <br />Pd a®~ ro a~ <br />AA:o,lt ' <br />Go Zip Code: 8/L~l <br />303 Telephone: 9~ ~-3~0/ <br />Security No.: `~ 4- 1L7.20~~{ <br />5, Application Fee: $100.00 <br />Make Check payable to the Division of Minerals and Geology <br />N~.~.- Nv <br />