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DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866 -3567 <br />FAX: (303) 832 -8106 <br />APPLICATION FORM <br />FOR TRANSFER OF MINERAL PERMIT AND <br />SUCCESSION OF OPERATORS <br />Permit Information <br />Permit Number : - 2007 -069 <br />Operation Name Pheasant Run Gravel Pit <br />Permittee Information <br />Contact Person: Ba rtmess <br />Company Name:Centennial State Paving, Inc. <br />Street AddressP•O. Box 11468 <br />cit <br />stateColorado <br />Phone: F19 )948 -2000 <br />Email (optional): jilncentpave @aculink_net <br />Prospective Successor Information <br />Contact Person: qmo <br />Company Name:Tony J. Reltramo and Sons, Inc. <br />Street Address 1541 Stockyard Rd. <br />cit yPueblo <br />Stateo <br />Phone: ( <br />/ 1 9 J tY <br />Email (optional): <br />Office of <br />Mined Land Reclamation <br />Inactive Mines <br />Zip: 81001 <br />Zip: 81001 <br />STATE OF COLORADO <br />ADMINISTRATIVE INFORMATION <br />Denver • Grand Junction • Durango <br />COLORADO <br />D I V I S I O N O F <br />RECLAMATION <br />MINING <br />— &— <br />SAFETY <br />RECEIVED <br />SEP 12 2012 <br />DIVISION OF RECLAMATION <br />MINING AND SAFETY <br />Office of <br />Active and <br />