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Colorado Department of Public Health & Environinent <br />)Water-Quality Control Division Pte <br />WQ,? _ P -r3z NOV 1 3 2008 <br />4300 Cherry Creek Drive South Month Year <br />Denver, Colorado 80246-1530 <br />,? - _ Mining Di a d Safe Yn? <br />NOTICE OF TRANSFER AND ACCEPTANCE OF TERMS OF A <br />STORMWATER DISCHARGE GENERAL PERMIT CERTIFICATION ? me?v/ <br />1) To be completed by the NRW Dermittee: <br />340849 ? wlxiah was <br />I hereby accept transfer of this Colorado Discharge Permit Certification No. COIL- 0 <br />issued to Alpine Rock Co. , I have reviewed the terms and conditions of this permit and the Stormwater <br />Jul28,2008 <br />Management Plan and accept full responsibility, coverage and liability. This transfer will be effective on: <br />1 qR 3-03s" <br />The facility site is located at: <br />Street Address NW 1/4, See 24, TGS, R77W <br />City, State and Zip Code - ' <br />Summit Swan River Resource <br />County Name of facility or development <br />The NEW permittee is: <br />Company Name ` <br />Mailing Address fl- Rn X_ - <br />City, State and Zip Code Phone No 9o 5. 37? <br />Legally Pesponsible Party (signatory) Email Address t ' "+a1n6 < <br />Local Contact (familiar with facility) -%] am .o t2 t' ?? ` Tide <br />Phone Number Email Address-j1a; cmL2 GO <br />I certify under penalty of law that I Lave 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 co plete. I am aware that there are significant penalties for submitting false information, including the <br />an t <br />possibility o), e <br />r i <br />Signature of Applic (Le onsible Party) Date Signed <br /> <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 refercneed permit and certification and all responsibilities <br />thereof. <br />Name Alpine Rock Co. <br />Mailing Address 14802 W, 44th Avenue <br />City, State and Zip Code Golden, Colorado 80403 <br />Phone Number (303) 279.6611 Email Address <br /> ?-5--0 <br />Signa of Permit Applicant (Legally Responsible Party) Date Signed <br /> <br />Name (printed) Title <br />1/08/cans