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x <br /> STATE OF COLORADO <br /> DIVISION OF RECLAMATION, MINING AND SAFETY , <br /> Department of Natural Resources <br /> 1313 Sherman St.Room 215 1 1 7022 C O L O R A D O <br /> L) [VISION o F <br /> Denver,Colorado 80203 <br /> RECLAMATION <br /> Phone.(303)866-3567 DIVISION OF Rz-Ct_AIMATIDN, MINING <br /> FAX: (303)832-810 MINING &SAP,-TY .--M'1NZF <br /> SAFETY <br /> APPLICATION FORM <br /> FOR TRANSFER OF MINERAL PERMIT AND <br /> SUCCESSION OF OPERATORS <br /> SO-4 <br /> CCWITHM <br /> ADMINISTRATIVE INFORMATION <br /> Permit Information <br /> Permit Number: M-1983-164 <br /> Operation Name: Gallegos Pit <br /> Permittee Information <br /> Contact Person: Gale Gallegos <br /> Company Name: Romeo Gravel, LLC <br /> Street Address: PO Box 517, Romeo CO 81148 (11395 US Hwy 285) <br /> City: Romeo <br /> State: CO Zip: 81148 <br /> Phone: ( ) 719-580-7682 <br /> Email (optional): <br /> Prospective Successor Information <br /> Contact Person: Don Martinez - Designee - Road & Bridge Director <br /> Company Name: Conejos County Government <br /> Street Address: 6683 County Road 13 <br /> City: Conejos <br /> State: CO Zip: 81129 <br /> Phone: ( 719-376-5654 ext 4 <br /> Email (optional): dmartinez@co.conejos.co.us <br /> Office of Office of <br /> Mined Land Reclamation Denver•Grand Junction•Durango Active and <br /> Inactive Mines <br />