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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY RECEIVED <br /> Department of Natural Resources R <br /> 4 �O�C COLORADO <br /> J 1313 Sherman St.,Room 215 DIVISION OF <br /> Denver,Colorado 80203 JUN RECLAMATION <br /> Phone:(303)866-3567 <br /> FAX:(303)832-8106 DIVISION®� N CLATE't MINING <br /> MINING AND SAFTEY SA ETY <br /> APPLICATION FORM <br /> FOR TRANSFER OF MINERAL PERMIT AND <br /> SUCCESSION OF OPERATORS <br /> ADMINISTRATIVE INFORMATION <br /> Permit Information <br /> Permit Number: A4 - a,o l/ - or, <br /> Operation Name: �Gti I L [ZOG lL q <br /> Permittee Information <br /> Contact Person: 13,.c pc wu..11•e,4 <br /> Company Name: A/1o,,,4„,,o s fy <br /> Street Address: 6 3t o L e,,$ (( i J <br /> City: _Alt s•(_ <br /> State: C..dlo ra,,0 Zip: 93[4dI <br /> Phone: ( `I 70 ) �,S - 7ao3 <br /> Email (optional): {jW all,h_G, P_ ma n fr05 Cc,�,„,c . -f- <br /> Prospective Successor Information <br /> Contact Person: t ( �c v.d <br /> J <br /> Company Name: Rock_ 13o{-f,o rr+ (z e.cs, <br /> Street Address: Pc) 13 o x 5 4) <br /> City: 4/e,r I. 4, J <br /> State: �`_�/o r e,dd Zip: $('•123 <br /> Phone: ( cl7c, ) S q G - G 7 t G <br /> Email (optional): Me, H-, kor L`pn�rae f� ahao, GG <br /> Office of Office of <br /> Mined Land Reclamation Denver•Grand Junction•Durango Active and <br /> Inactive Mines <br />