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)-44-o/Toct <br />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 />RECEIVED <br />OCT 25 2012 <br />DIVISION OF RECLAMATION <br />- MINING AND SAFETY <br />Permit Information <br />Permit Number: /t'/ f ?gam ,_ ) z 4 <br />Operation Name: ��� f u <br />Permittee Information <br />Contact Person: <br />Company Name: <br />Street Address: <br />City: f, a-re <br />State: <br />�3 • <br />Phone: ( ==s> <br />Office of <br />Mined Land Reclamation <br />Inactive Mines <br />Email (optional): cier, 11 P e J <br />Prospective Successor Information <br />Contact Perso "J /n/ <br />Company Name: <br />Street Address: <br />City: ( i e <br />Phone: (qZU ) 3 <br />Email (optional): <br />APPLICATION FORM <br />FOR TRANSFER OF MINERAL PERMIT AND <br />SUCCESSION OF OPERATORS <br />ADMINISTRATIVE INFORMATION <br />®e X14 G , -P J/ <br />6S2 cx3 , & k () Ck <br />nc. <br />Zip: <br />STATE OF COLORADO <br />SO 933 74 <br />`34--1 <br />3 e, Q' 9 ilmt <br />A <br />State: Zip: *) ( — CU <br />7e) <br />4-3 <br />0 3 <br />Denver • Grand Junction • Durango <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />— &— <br />SAFETY <br />John W. Hickenlooper <br />Governor <br />Mike King <br />Executive Director <br />Loretta Pineda <br />Director <br />Nov Non ox._ "p <br />t)-tv - -ro /zy �Zo�� <br />Office of <br />Active and <br />