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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY ..�., `S� <br /> Department of Natural Resources RECEIVED <br /> V <br /> COLORADO <br /> 1313 Sherman St.,Room 215 JUL 30 2024 DIVISION OF <br /> Denver,Colorado 80203 RECLAMATION <br /> Phone:(303)866-3567 MINING <br /> FAX:(303)832-8106 Colorado Division of Reclamation, <br /> Mining and Safety SAFETY <br /> APPLICATION FORM <br /> FOR TRANSFER OF MINERAL PERMIT AND <br /> SUCCESSION OF OPERATORS <br /> ADMINISTRATIVE INFORMATION <br /> Permit Information <br /> Permit Number: I " �9q ` 01 <br /> Operation Name: . Ptak <br /> Permittee Information <br /> Contact Person: L . <br /> ReovAlci L . Bo.' -eT ex-- <br /> Company Name: / 1, M• l..oh�A-,`claim&I <br /> Street Address: .S 8(p Z 00urt1j Roca JO (o 5au.±k <br /> City: A (ar^O s0. e <br /> State: Cp(ttJ' Zip: g( (0 ( <br /> Phone: (lie ) g SO - g 5OO <br /> Email (optional): <br /> Prospective Successor Information AA <br /> Contact Person: / 1 accA3 W. MQf F <br /> L hJL.K.. <br /> Company Name: Ma 1 P_.t se&c Ll3 SCci_e_ !c rl l i n L•�.�. <br /> Street Address: 58 6,g LimuLti epeLel !f 4, 5 ectit <br /> City: A a.IIkp I.SC <br /> State: Le.lerado Zip: gun' <br /> D' <br /> Phone: (`70 ) 58O - <br /> Email (optional): mp t Q& 1 O� Q M fit . dif5 <br /> Office of Office of <br /> Mined Land Reclamation Denver•Grand Junction•Durango Active and <br /> Inactive Mines <br />