Laserfiche WebLink
Permit Information <br />Permit Number: <br />S RECEIVED <br />MAR 302012 <br />- 4 - Division of Reclamation, <br />Mining & Safety <br />APPLICATION FORM FOR TRANSFER OF MINERAL PERMIT <br />AND SUCCESSION OF OPERATORS <br />ADMINISTRATIVE INFORMATION <br />M fft`1Ai- 1I1 <br />Operation Name: Go1cl -N: I 1 milt <br />Permittee Information ��++ ,�,, <br />Contact Person: W 7- Co S Qec.e I c„e "e- -4 - <br />Company Name: A G C Q�Soc� -IQ� t _t_ <br />Street Address: 5 X<IY3 ETC f x ock - , 5.5,-:4 $ <br />City: GR-fe e.r1 LAN acsa VI l kne <br />State: CLal2 o Zip: Sol 1 1 <br />Phone: 33137% --( <br />Email (optional)0 cc rd C-Sc o- con1 <br />Prospective Successor Information <br />Contact Person: )vtra_iLK_ A. - S4Qe-n <br />Company Name: &::›I4 44: 11 bet • . :cic . <br />Street Address: 9 5 1 1(2 4 QaR.M l-mnQ. <br />City: i—on Oleiry t <br />State: 6 01012 ° 41 ° Zip: 80503 <br />Phone: (o51 - 2985 <br />Email (optional)5004- ine@ _30n0a: corn <br />qb m ,, , 2o I - 03 3 <br />/4 L MV- /a- oos' <br />4- r &t.A-€ 7/a6laai2, <br />