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STA~~ of coLo~Do <br />DIVISION OF MINERALS AND GEOIOGYRECEBVE~ <br />Department of Natural Resou¢es <br />1313 Sherman SL, Room 21 i <br />Denver, Colorado 80?03 <br />Phone: (3 031 866-316 7 <br />FAY: (3031 83'?-H 106 <br />PIa•'N{'2 ~ (•UW <br />Uirision of Minerals and Geology <br />TRANSFER OF PERMIT AND <br />APPLICATION FORM <br />OF OPERATORS <br />~~ <br />DEPARTMENT CF <br />NATURAL <br />RESOURCE <br />Roy Romer <br />Governor <br />lames S. Lochhead <br />Executive Direttor <br />Michael R. Long <br />Bivision-Dirocwc - - _ _ <br />The application for a Transfer of Permit and Succession of Operators must contain four (4) major parts: 1) an Application <br />Form; 2) an Application Fee; 3) a Performance 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 notarized signature. To expedite processing, please provide the information in the format <br />and order described below. <br />I. FINANCIAL WARRANTY INFORMATION (~ <br />Permit #: K-1445- 04 7 Confidental?: ~ <br />Class: r rsic-r- Type-Seq.: So <br />From:1.t4?"•,._4.n.~usl,?,-Hrne CareTo:_ ~j ~'tG <br />Doc. Name:SD'•' `I I ~ Preuxl+~Fo.JJea.~ Sn~-naglu~ <br />Doc. Date (if no date stamp): 8/a (/O <br />~fS~iPH a5/S 91oD•oa <br />1.Oration A / R ~ ~m3 I wish to W TVF MY t .HT to a 30-day processing time to allow <br />(Initial & Date) the Division of Minerals and Geology to recalculate the Financial <br />Warranty requirements. <br />2. don B: I DO NOT WISH TO WAIVE MY RIGHT to a 30-day processing <br />(Initial & Date) 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 rectamatiort bond within 60-days from the date <br />that the transfer is completed and the required FRJANCIAL <br />WARRANTY COULD BE Sl]BSTANTIALLY INCREASED at that <br />time. As the new operator, 1 agree to be responsible for posting any <br />required increase to the financial warranty for good cause shown, in a <br />form acceptable to the Boazd, within 60-days of such notice. <br />NoV=~vovV~ <br />