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_,,,( W► i�Ra- loz <br />�`� STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Dep=ncnt of Nctural :kesources <br />D I COtpILADO <br />1319 Sherman St., Room 215 V D I V E 5 E O h OF <br />Denver, Colorado 86203 � RECLAMATION <br />Rime; (303) 86&3567 MINING <br />FAX: (303) 832 - 8106 <br />SAT Hy <br />APPLICATION FORM <br />FOR TRANSFER OF MINERAL PERMIT AND <br />SUCCESSION ESSION O F OPERA'T'ORS <br />RECEIVED <br />ADMINISTRATIVE INFORMATION FEB 10 2015 <br />DIVISION OF RECLAMATION <br />Permit Information MINING AND TYPW <br />[permit Number: S �. —b - a o � <br />Operation Nalna`: M - Lqa - (� �►/ �/ -(D,lS <br />Permit-tee Information <br />Contact Person: <br />Company Name: -Sb6 —( n rG oe-( 7Li(°- <br />Street Address: j? '?-a al ( N � , i�w P VI A <br />City:­ ra') &e <br />Stale: _0 ,Zip, <br />Phone: L I - <br />Email (optional): rJ�a, I in Q l LS-�r <br />Prospective Successor Information <br />Contact Person: �'f' -�� -OWA40 L 5uPP65 <br />�Com any Na v @- � <br />fPr <br />Street Address: 6 0) Al Par % <br />Citv: <br />State: ('� Zip: <br />Phone: 7 0) _2�Y_i 13 <br />Email (optional ): Q,pRLJo,Jes @rte►onJ_L P -f <br />1, [/14 11 <br />-Zff 0 � #w <br />Office of <br />Office of <br />Mind Land Reclamation Denver - Grand Junction • Durango Active and <br />Inactive-Mines <br />