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)1121 17 Giktf <br /> w` STATE OF COLORADO <br /> DIVISION OF RECLAMATION, MINING AND SAFETY <br /> Department of Natural Resources <br /> 1313 Sherman St.,Room 215 COLO R A D O <br /> DIVISION OF <br /> Denver,Colorado 80203 <br /> RECLAMATION <br /> Phone:(303)866-3567 AO, <br /> ,y ✓/b MINING <br /> FAX(303)832-8106 1 l� —&— <br /> SAFETY <br /> APPLICATION FORM <br /> FOR TRANSFER OF MINERAL PERMIT AND <br /> SUCCESSION OF OPERATORS <br /> ADMINISTRATIVE INFORMATION <br /> MAY 1 : L ":3 <br /> Permit Information <br /> ,_Pciamation, <br /> Permit Number: M-2012-024 t,.„.,,;y(.2.,Safety <br /> Operation Name: Warren Gravel Pit <br /> Permittee Information <br /> Contact Person: Richard A. Hansen <br /> Company Name: Garnet Mesa Investments, LLC <br /> Street Address: Post Office Box 492 <br /> City: Delta 1I7-4, <br /> State: Colorado Zip: 81416 <br /> ✓5 ) <br /> Phone: 70 ) 874-6373 v, v rr 4 <br /> Email (optional): / /1 rrt i24L <br /> W/1v1� <br /> Prospective Successor Information 61AL ii/if 1 <br /> Contact Person: Richard A. Hansen A n� <br /> Company Name: Burr Oak Investments, LLC t its 1 <br /> Street Address: Post Office Box 492 - >t r 1n.41" <br /> City: Delta <br /> State: Colorado Zip: 81416 <br /> Phone: (970 )874-6373 <br /> Email (optional): <br /> Office of Office of <br /> Mined Land Reclamation Denver•Grand Junction•Durango Active and <br /> Inactive Mines <br />