2012-03-08_REVISION - M1999047

• Permit No: M1999047
• IBM Index Class Name: REVISION
• Doc Date: 3/8/2012
• Doc Name: TRANSFER OF PERMIT & SUCCESSION OF OPERATORS APPLICATION FORM
• From: DRY CREEK GULCH FARMS
• To: DRMS
• Type & Sequence: SO3
• Email Name: ECS
• Email Name: TAK
• Media Type: D
• Archive: No

II. ADMINISTRATIVE INFORMATION:
1. Permit Number:
2. Operation Name:
3. Current Permitted Operator:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
-2-
M- 1999 -047
Adamson Bros Mine
Lynn D. Adamson
Make check payable to the Division of Reclamation, Mining and Safety
Adamson Brothers & Sons Feedlot, Inc.
34360 County Road RR, P.O. Box 321
Wray
Colorado zip Code: 80758
970 Telephone: [phone]
4. Successor Operator:
Contact Person: Shane Galles
Company Name: Dry Creek Gulch Farms, LLC
Street: 505A East 8th Ave.
City: Yuma
State: Colorado Zip code: 80759
Area Code: 970 Telephone: [phone]
IRS Tax ID No. or Social Security No.: 26- 2507906
5. Application Fee: $115.00 for Hard Rock operations; $144.00 for Construction Materials operations