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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 />STATE OF COLORADO <br />J0,0 ( <br />APPLICATION FORM <br />FOR TRANSFER OF MINERAL PERMIT AND <br />SUCCESSION OF OPERATORS <br />Permit Information <br />Permit Number: <br />Operation Name <br />ADMINISTRATIVE INFORMATION <br />50 <br />Permittee Information <br />Contact Person: <br />Company Name: <br />Street Address: <br />City: <br />State: Zip: <br />Phone:-( aO— <br />Email (optional): <br />Prospective Successor Information <br />COLORADO <br />D IVI S I ON Of <br />RECLAMATION <br />MINING <br />SAFETY <br />RECEIVED <br />1 N <br />'JUN 12 2015 r,4d-c- <br />Division of Reclamation, <br />Mining & Safety <br />Contact Person: <br />Company Name: ��� � � 2umd <br />Street Address: f Co_76_� <br />V f14 <br />�Q <br />C (6 ✓ , �N <br />City: F <br />ef� n,' <br />State: � Zip: 0—] c) a4 A A&/" <br />(G -m )Baa--���� t� i i 11 <br />ILt <br />Phone: � J 1 IZ5 bto <br />Email (optional): qe+, c j-, C Ls3eAW-L 1/I. <br />Office of Office of <br />Mined Land Reclamation Denver • Grand Junction • Durango Active and <br />Inactive Mines <br />