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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY R E C E 1 V E n <br /> Department of Natural Resources <br /> FEB0 3 2023 C O L O R A D O <br /> 1313 Sherman St.,Room 215 D I V I S I O N o f <br /> Denver,Colorado 80203 RECLAMATION <br /> Phone:(303)866-3567 DIVISION OF RECLAMATION, MINING <br /> FAX:(303)832-8106 MINING &SAFETY-MINERALS <br /> SAFETY <br /> APPLICATION FORM <br /> FOR TRANSFER OF MINERAL PERMIT AND <br /> SUCCESSION OF OPERATORS <br /> ADMINISTRATIVE INFORMATION SO-5 <br /> ERR/MAC <br /> *1D <br /> Permit Information A� <br /> Permit Number: M 1 g g-j-o g y SO <br /> Operation Name: 6'Gorl 1t -Z- <br /> Permittee Information <br /> Contact Person: J o�,' ,��4_1_P'44-;z(CY- <br /> Company Name: /-a—lid Z-/-� <br /> Street Address: <br /> City: /19EAa-i� f,e <br /> State: L ou_.i nn Q Zip: 2zooI <br /> Phone: ( wy ) e2,/,I- 7//Z <br /> Email (optional): <br /> Prospective Successor Information <br /> Contact Person: Sc,T 'j"N,,)s,e_", <br /> Company Name: C6 a e L_L C <br /> Street Address: io q 2- �0.13�x,23--�L3 <br /> City: <br /> State: L"� Zip: gd y yz. <br /> Phone:( q-7o ) 9py-6i01 <br /> Email (optional): S l r���v►�h �6 ��T�7cz L �3.1 <br /> Office of Office of <br /> Mined Land Reclamation Denver•Grand Junction•Durango Active and <br /> Inactive Mines <br />