REV08625

• Permit No: M1977151
• IBM Index Class Name: Revision
• Doc Date: 7/23/1993
• Doc Name: TRANSFER OF PERMIT AND SUCCESSION OF OPERATORS APPLICATION FORM
• Type & Sequence: SO4
• Media Type: D
• Archive: No

,:
~IIII~II~~I~~~~~~I~ • '~
999 -~ STATE OF COLORADO
DIVISION OF MINERALS AND GEOLOGY
Department of Natural Resources ab°_~~
7313 Sherman SL, Room 215 ~`: 'ti
Denver, CO RC203 ~~ • `~ •!
Phone.13U3~d'ob-SSb7 /~l ass •
FAX: i 3U 37 !'32-H I U6
OIL/S~ ~~` Roy Romer
we~nor
TRANSFER OF PERMIT AND SUCCESSION OF OPERATORS/~~''~/sy 99~~~~ae~o~«~or
APPLICATION FORM G~'oi
~yl
The application for a Transfer of Permit and Succession of Operators must contain four
(4) major parts: 1) an Application Form; 2) an Application Fee; 3> a Performance
Warranty (attached as part of the Application Package) bearing the original notarized
signature of the Successor Operator; and, 4) a replacement Financial Warranty provided
by the Successor Operator, bearing an original notarized signature. To expedite
processing, please provide the information in the format and order described below.
I. ADMINISTRATIVE INFORMATION
1. Permit Number:
2. Operation Name:
3. Current Permitted Operator:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
4. Successor Operator:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
IRS Tax ID No.
M-77-151
~~ -o~`f
Greelev Gravel Pi't
l ,I
Curtis E. Strong
P. 0. Box 10
Platteville
Co Zip Code: 80651
(303) Telephone: [phone]
Rex Hiner
R. M. Hiner Construction Company. Inc.
2220 "0" Street
Greeley
CO Zip Code: 80631
(303) Telephone: [phone]
or Social Security No.: ~s4-0~40'l0
5. Application Fee: 5100.00 ~ ~, _ ~_ 3 U-q y i
Make check payable to the Division of Minerals and Geology
~,1pU • - Nl~