2012-03-02_REVISION - M2006010

• Permit No: M2006010
• IBM Index Class Name: REVISION
• Doc Date: 3/2/2012
• Doc Name: TRANSFER OF PERMIT & SUCCESSION OF OPERATORS APPLICATION FORM
• From: MS FOREST, LLC
• To: DRMS
• Type & Sequence: SO1
• Email Name: SJR
• Email Name: TAK
• Email Name: SJM
• Media Type: D
• Archive: No

II. ADMINISTRATIVE INFORMATION:
I . Permit Number:
2. Operation Name:
3. Current Permitted Operator.
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
4. Successor Operator:
Contact Person:
Company Name:
Street:
City:
State:
Area Codc:
IRS Tax ID No. or Social Security No.:
M- 2006 -010
MSF /Feister Pit #1
Ms. Mary Shaw Canda
MS Forest, LLC
PO Box 521
Aguilar
CO Zip Code: 80120
719 Telephone: [phone]
Phil DoreniCamp
Las Animas County
2000 N. Linden
Trinidad
CO Zip Code: 81082
719 Telephone: [phone]
84- 6000780
5. Application Fee: $115.00 for Hard Rock operations; $144.00 for Construction Materials operations
Make check payable to the Division of Reclamation, Mining and Safety