REV104399

• Permit No: M1979205
• IBM Index Class Name: Revision
• Doc Date: 5/3/2000
• Doc Name: TRANSFER OF PERMIT AND SUCCESSION OF OPERATORS APPLICATION FORM
• Type & Sequence: SO4
• Media Type: D
• Archive: No

:
II.

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ADMINISTRATIVE INFORMATION:
1. Permit Number:
2. Operation Name:

MMM/CHAMBERS PIE
3. Current Permitted Operator:
Contact Person:
Company Name: -
Street:
City:
State:
Area Code:
4. Spccessor Operator:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
IRS Tax ID No. or Social Security No.
RTi.T. RATi.F.Y
OM R SH N TN ..
P.O. BOX 1556
Co Zip Code: 81650
970 Telephone: [phone]
PAIR. MCQRHRF.
UNITED COMPANIES OF MESA COUNTY. INC.
P.O. BOX 3609
(:RAND .TIINCTION
CO Zip Code: 81502
970 Telephone: [phone]

5. Application Fee: $100.00
Make check payable to the Division of Minerals and Geology