REV100325

• Permit No: M1990025
• IBM Index Class Name: Revision
• Doc Date: 12/1/2000
• Doc Name: TRANSFER OF PERMIT & SUCCESSION OF OPERATORS APPLICATION FORM
• Type & Sequence: SO2
• Media Type: D
• Archive: No

I.

_~.
ADMIMSTRATIVE iNEOIL~[ATTON:
1. Permit Number:
r1-1990-025
2. Operation Name:
Gardner Pit No. 2A
3. Current Permitted Operator:
Contact Person:
Company Name:
Street:
City:
State:
Area Cade:
4. Successor Ocerator:
Contact Person:
Company Name:
Street:
City
State:
Area Code:
IRS Tae ID No. or Social Security No.:
William K. Goode
HAYCAMP GRAVEL INC.
P 0 BOX 656
CORTEZ
COLORADO Zip Code: 81321-0656
9 7 0 Telephone: [phone]
Aryol Brumley, Manager
Four States Aggregates, LLC
PO Box 1568
CORTEZ
COLORADO Zip Code: 81321-1568
9 7 0 Telephone: [phone]

5. ApnlicaGonFee: $100.00 for Hard Rock operations; $125.00 for Construction Materials
operations
Make check payable to the Division of Minerals and Geology