REV105307

• Permit No: M1983090
• IBM Index Class Name: Revision
• Doc Date: 4/21/1994
• Doc Name: TRANSFER OF PERMIT & SUCCESSION OF OPERATORS APPLICATION FORM
• Type & Sequence: SO3
• Media Type: D
• Archive: No

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999 _ ~F COLORP~DO
DIVISION OF AIINCRALS ANU GCULOGY
Department of Nawral Resources f~F ^F IV
L._ i t=r~
1311 Shemun SI., Room 215
~~~, co oozol N ~'~ ? 1 1994
Yhonc: U03) BL6~JSG7
FA%:(]0])812.8106
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TRANSFER OF PERMIT AND SUCCESSION OF OPERATORS
APPLICATION FORM
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Rov Nunes
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M~~luel P. l w~F
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The application for a Transfer of Permit and Succession of Operators must contain four
(4) major parts: 1) an Applic~ition form; 2) an Application Fee; 3) a Performance
Warranty (attached as part of i:he Application Package) bearing the original notarized
signature of the Successor Operator; and, 4) a replacement Financial Warranty provided
by the Successor Operator, bearing an original notarized signature. To expedite
processing, pease provide the information in the format and order described below.
~0-~03
I. FINANCIAL WARRANTY INFORMATION:
It 1s your responsibility to ensure that the financial warranty you post is
adequate to cover the complete cost of reclamation liability you assume by
execution of this Permit Transfer.
The Board has the right to increase the financial xarranty for good cause shorn.
If after permit transfer, the Board determines that the financial xarranty you
post is not adequate to cover the complete cost of reclamation, the Board may
require you to post additional financial xarranty xi thin GO days of notice to you.
IT. ADMINISTRATIVE INFORMATION: ,~~ << ht,~~(c•:
1 . Permit Number: rt - 83 -090
2. Operation Name: t.~ Pouclre sand s fravet
3. Current Permitted Operator:
Contact Person:
Company Namc:
Street:
City:
State:
Area Codc:
t.ee House
r R ~ I
PO 13x 33 __~
Kirk

Te 1 epl~nnc:
Zip Code : RI~L4