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STATE OF COLORADO <br /> DIVISION OF RECLAMATION, MINING AND SAFETY <br /> � �� �Department of Natural Resources <br /> 1313 /� COLORADO <br /> Sherman St.,Room 215 MAY 1 1 201? �//" RECLAMATION <br /> Denver,Colorado 80203 <br /> Phone:(303)866-3567 MINING <br /> FAX:(303)832-8106 01VISION OF RECLAMATION SAFETY <br /> MINING AND SAFETY <br /> APPLICATION FORM <br /> FOR TRANSFER OF MINERAL PERMIT AND <br /> SUCCESSION OF OPERATORS <br /> ADMINISTRATIVE INFORMATION <br /> Permit Information <br /> Permit Number: <br /> Operation Name: <br /> Permittee Information <br /> Contact Person: 1�xb,—�, t-4- -1'::) <br /> Company Name: S e 'a i <br /> Street Address: 1-4610 i- (e <br /> City: i L Lvibt l <br /> State: Zip: 0161r' <br /> Phone: (��3 ) J S(t '(O�3 `i" <br /> Email (optional): <br /> Prospective Successor Information _ <br /> Contact Person: ( e-1 Le-1 6 -r' Od M �W X <br /> Company Name: S'C l 2 c;t 0, %t-) I � <br /> Street Address: <br /> city: du& 0,2--4 7 <br /> State: Zip: g o� <br /> Phone: <br /> Email (optional):C) i C P <br /> Office of Office of <br /> Mined Land Reclamation Denver•Grand Junction•Durango Active and <br /> Inactive Mines <br />