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C� STATE OF COLORADO <br /> DIVISION OF RECLAMATION, MINING AND SAFETY <br /> Department of Natural Resources <br /> COLORADO <br /> 1313 Sherman St.,Room 215 D I V 1 5 1 ON OF <br /> Denver,Colorado 80203 RECLAMATION <br /> Phone:(303)866-3567 /� MINING <br /> FAX:(303)832-8106 V —&— <br /> SAE ETY <br /> APPLICATION FORM <br /> FOR TRANSFER OF MINERAL PERMIT AND <br /> SUCCESSION OF OPERATORS <br /> ADMINISTRATIVE INFORMATION <br /> Permit Information RECEIVED <br /> Permit Number: <br /> Operation Name: /7 e_� APR 1 : wig 17 <br /> Permittee Information � �, <br /> Contact Person: IV Iq _// <br /> Company Name: —sd�I�j�/� c<�� /IGI,G�r G16GZ 45� At �aS1 <br /> Street Address: <br /> City: "QT-afzt2 <br /> State: �a Zip: 'Ll- 0 D v/ ✓ .,�, <br /> Phone: <br /> Email (optional): SGULt� f! <br /> ry V <br /> Prospective Successor Information (( ✓l J q-At <br /> Contact Person: ,T,-d l z 6L A 44 �1�14 <br /> Company Name: 6 P^ L , 1' <br /> Street Address: D/ <br /> City: L �G� <br /> State: �� Zip: <br /> Phone: 2 / `J//Z <br /> Email (optional): Sp r <br /> Office of Office of <br /> Mined Land Reclamation Denver•Grand Junction-Durango Active and <br /> Inactive Mines <br />