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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 />So V& <br />APPLICATION FORM <br />FOR TRANSFER OF MINERAL PERMIT AND <br />SUCCESSION OF OPERATORS <br />ADMINISTRATIVE INFORMATION <br />Permit Information <br />11Z6 Permit Number: M k9 5-7 — O <br />COLORADO <br />DIV IS I ON Of <br />RECLAMATION <br />MINING <br />SAFETY <br />RECEIVED <br />Cr7�C- <br />MAY 14 2015 <br />Division of reclamation, <br />Mining & Safety <br />w 7VV� <br />Operation Name: Q� t ►-� Er .� �� ?�^ <br />Permittee Information <br />Contact Person: <br />Company Name: �� V'1 'V -'Core- \" P��m; ��� i%P O2 <br />Street Address: 3 4 q O SLa'op 1a>(00 <br />City: 14TU4QTA <br />State: R Zip: 30 3O S <br />Phone: i CD ) `702 — 00 �'t� -1 � C�� r� <br />�q <br />Email (optional): <br />Prospective Successor Information <br />Contact Person: t ).d ,l1 I r'l ? `(%r r;'0 0 <br />Company Name: M G n o -Y-6 1 fyi � in 5 � t f eg PSS I LL!✓ <br />Street Address: 3 4 G O P Uzi.-�M OY1 Lack L<) l e— �3(Do <br />City: &La-tA.t-z1-- <br />State: Gk <br />Zip: 30 305 <br />Phone: (:�,03) 4 Zai — a 1 1 � <br />✓m'i d .-�rvt <br />r/ AJ D Fin. f - <br />Email (optional): �C <br />Office of Office of <br />Mined Land Reclamation Denver • Grand Junction • Durango Active and <br />Inactive Mines <br />