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RECEIVED <br />Print Fonn <br />Colorado Department of Public Health & Environment <br />Water. Quality Control Division Rec - <br />WQCD - P - s2 NOV 13 2008 L---. <br />4300 Cherry Creek Drive South Eff <br />Denver, Colorado 80246-1530 Division of rteciamation, Month Day Year <br />-fO-. Mining and Safety ? met- ate/ CZ? vj <br />NOTICE OF TRANSFER AND ACCEPTANCE OF TERMS OF A <br />STORMWATER DISCHARGE GENERAL PERMIT CERTIFICATION a-!-' <br />1) To be completed by the NEW permittee: <br />340849 , which was <br />I hereby accept transfer of this Colorado Discharge Permit Certification No. COR- 0 <br />issued to Alpine Rock Co. . I have reviewed the terms and conditions of this permit and the Stormwater <br />Jul 28, 2008 <br />Management Plan and accept full responsibility, coverage and liability. This transfer will be effective on: <br />The facility site is located at: <br />Street Address NW 1/4, Sec 24, TGS, R77W <br />City, State and Zip Code <br />County Summit <br />The NE' <br />Compan <br />Mailing <br />Swan River Resource <br />Name of facility or development <br />-01 - <br />City, State and Zip Code I' NI?G M )Phone No '7W -!TS 2- <br />Legally Responsible Party (signatory) Email Address IOl b2it s tk. co • VS <br />Local Contact (familiar with facility) 12 ICl?V1 ?,Ol? G? Title-t?ld-e (?? ? "A ?vp a /'p ??ZCt'.c l S <br />Phone Number Email Address UAA L (m 5LI VIA" t if <br />I certify under penalty of law that I have personally examined and am familiar with the information submitted herein, and <br />based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the information <br />is true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the <br />p sibility fie and imprisonment. <br />of Permit A lic t (Legally ResphsiAe Party) <br />Date Signed <br />?? ? 1?'/LTlA?F?/ _' Cyun!(ii ?t/hyrttrr"K? <br />Name (printed) Title <br />2) To be completed by the Previous permittee: <br />As previous permittee, I hereby agree to the transfer of the above referenced permit and certification and all responsibilities <br />thereof. <br />Name <br />Alpine Rock Co. <br />Mailing Address 14802 W. 44th Avenue <br />Ci, State and Zip code Golden, Colorado 80403 <br />ty <br />Phone Number (303) 279-661 .1 - <br />Email Address <br />P-S-Dr- <br />Sign re of Permit Applicant (Legally Responsible Party) Date Signed <br />Name (printed) <br />1/08/trans <br />Approved as <br />to form <br />1'6--- <br />Legai <br />Title