2015-01-21_REVISION - M2012007

• Permit No: M2012007
• IBM Index Class Name: REVISION
• Doc Date: 1/21/2015
• Doc Name: Incomplete Application SO01
• From: O'Rourke Excavating, Inc.
• To: DRMS
• Type & Sequence: SO1
• Email Name: RCO
• Email Name: GRM
• Email Name: BJC
• Media Type: D
• Archive: No

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DIVISION OF RECLAMATION, MINING AND SAFETY
Department of Natural Resources
n "M PLC
STATE OF COLORADO
1313 Sherman St, Room 215
Denver, Colorado 80203
Phone: [phone]
FAX: [phone]
JAN 21 2015
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APPLICATION FORM
FOR TRANSFER OF MINERAL PERMIT AND
SUCCESSION OF OPERATORS
DIVISION OF RECLAMATION
MININGANDSAFETY ADMINISTRATIVE INFORMATION
Permit Information
Permit Number: 14— 2 0 / ;Z —007,
Operation Name: a IR U ur /-e F;
Permittee Information
Contact Person: Om 9 S D OeA
Company Name: �i2oa v' kG- e5�'X va TV) C
Street Address: � ±2 y G /�. /S'
City: c-�o a 7'/ 'F-o N k
State: GO Zip:
Phone: J 2 /C/ ) v 3119 — % 6 O Z.
Email (optional): o ro u r lt e e,XGa v
Prospective Successor Information
COLORADO
DIVISION Of
RECLAMATION
MINING
SAFETY
Contact Person: 61e V.4AJ
Company Name:�,,1
Street Address: 6y�¢9 iR / Ot/0,
City: Ad/Lk © =5A ✓ /1/ jJ v
State: C 0 Zip: K/l O I "
Phone: ( 7 f 9 )
Email (optional):
V gv% "k 5 /tljy
;FWGl uwy II 'Wrs
Office of Office of
Mined Land Reclamation Denver • Grand Junction • Durango Active and
Inactive Mines