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STATE OF COLORADO <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 />i'v) 56 0 - <br />APPLICATION FORM <br />FOR TRANSFER OF MINERAL PERMIT AND <br />SUCCESSION OF OPERATORS <br />ADMINISTRATIVE INFORMATION <br />Permit Information // <br />Permit Number: p%-- [ 9 ly — 0 7 C, <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />SAFETY <br />RECEIVED <br />DEC 0 4 2015 <br />Division or Reclamation, <br />Operation Name: Gc. W\ c., NL4 kr/ rJ Mining & Safety <br />Permittee Information <br />Contact Person: -Ph u., % P Ai, <br />Company Name: D , <br />Street Address: i z S'' u�4- <br />n <br />City: F��� �-K.e ave <br />State: iN e ..vkke. R 41 L U Zip: c' 7 L4 0 I <br />Phone: ( j 5') - G — 2 /3 ? <br />Email (optional): <br />(41,4 on/oPik <br />t1 t�zGGS <br />Prospective Successor Information <br />tA <br />Contact Person: C <br />Company Name:> :' d41liW <br />Street Address: 19, (C�7 C_Offi PASS G1, t�C' <br />City: Dr. cPP/A) G S <br />State: c5( Zip: 70 62-0 <br />Phone: ( b7C) G73S <br />Email (optional): fl Q1641 36)._Ac,L. <br />Office of <br />Mined Land Reclamation <br />Inactive Mines <br />Denver • Grand Junction • Durango <br />Office of <br />Active and <br />