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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 DI L S R A D O <br /> DVISION OF <br /> Denver,Colorado 80203 RECLAMATION <br /> Phone:(303)866-3567 MINING <br /> FAX:(303)832-8106 —�t <br /> SAF ETY <br /> APPLICATION FORM <br /> FOR TRANSFER OF MINERAL PERMIT AND <br /> SUCCESSION OF OPERATORS <br /> ADMINISTRATIVE INFORMATION RECEIVED <br /> or/Ni(1I�V�LS <br /> Permit Information NOV 18 2616 <br /> M2008-001 <br /> Permit Number: ,, <br /> Operation Name: Blue Grass Gravel Pit IOQutwg,6 ' <br /> Permittee Information <br /> Contact Person: John Sliman <br /> Company Name: Southwest Farms, Inc. <br /> Street Address: 1825 Chianti Ct. <br /> City: <br /> Pueblo <br /> State: Colorado Zip: 81001 <br /> Phone: ( 719 ) 240-2575 <br /> ad <br /> Email(optional): jfs57@comcast.net i/ itJzA(I <br /> 1/ <br /> Prospective Successor Information �l�✓11 `�y✓' <br /> Contact Person: Anthony Adza rki,;,to' <br /> .714 <br /> Company Name: EWSD I, LLC riay <br /> Street Address: 600 Wilshire Blvd. 5 '�2 j J oo <br /> Los Angeles <br /> City: q <br /> State: California Zip ` 00 1'? <br /> Phone: ( 949 ) 236-9206 <br /> Email(optional): aadza@medbox.com <br /> Office of Office of <br /> Mined Land Redamation Denver•Grand Junction•Durango Active and <br /> Inactive Mines <br />