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STATE OF COLORADO DIVISION OF MINERALS AND GEOLOGY 1/~ Department of Natural Resources 13135herman St., Room 215 ~, RECEIVED Denver, Colorado 80203 qE~M~~C Phone: t303) 866.3567 DECO ~ LWJ ~-~ FAX: D03) 832A706 S C~ ~ , //~~ Gl b ~C(S U~ ~~ mrision of Minerals and Geology ' ~ J ~~ TRANSFER OF PERMIT AND SUCCESSION OF OPERATORS APPLICATION FORM f ~~Zb~~ /Gg~/ s~-t COLORADO DIVISION O F MINERALS GEOLOGY RECLA NATION•NINING SAEE TY•SCIENCF Bill Owens Govertwr Russell George Executive DIRYiOr Ronald W. Catgny Division Director Natural Resource Trustee This form bas been approved by the Mined Laid Reclamation Board pursuant fo sections 34-32-117, GRS, of flee Mined Land ReclamalionAa and 34-32.5-117, C.RS., ojthe Colorado LandReclmnation AdjortheExbadion of Construction Materiak Any alteration or modification ojAlEis jorm, xdtltout approval by theBoard skull rarrlt in thefurancw[warrmuybeorgb:wi6dandresu86E the voiding ojany permit issued in conjunction with such invalid fawuciol xwrranty and subject the operator to cease and desist orders and civilpenattiesjor operating »7tliout apermitpursuant to sections 34-32-123, GRS., ojtlieMinedLandReclama7ionAd and 34-32.5-123, GRS., ojthe Colorado Laud Redmnation Ad jar the Exaraction ojConstrraction Materials. The application for a Transfer of Petmit and Succession of Operators must contain fow (4) major parts: 1) an Application Form; 2) m Application Fee; 3) a PerfornrerKe Warranty (attached es part of the Application Package) hearing the original notarized signature of the Successor Operator; and, 4) a replacement Financial Warranty provided by Ule Successor Operator, bearing an cEiginel notarized signature. To ex~ledite processing, please provide the information in the format and order described below. F~IANCIAL WARRANTY INFORMATION tChoose ONE Option): 1. tion A: ~~//30.~wish to WAIVE MY RIGHT to a 30-day processing time to allow the (Initia] & Date) 2. Option B: (Initial k Date) Office of Mined Land Reclamation Division of Mmel-als and Geology to recalculate the Financial Warrenry requirements. Ifyou choose Option A you should not submit a Financial Wertunty end Perforramce Warranty until the Division notifies you of the correct amount of your warranty requirements.; I DO NOT WISH TO WAIVE MY RIGHT to a 30-clay processing time. I hereby submit a replacement Financial Warranty for the same dollaz amount as the Financial Warranty maintained by the current operator. I understand that the Division of Minerals and Geology will recalculate the required reclamation bond within 60-days from the date that the transfer is completed and the required FINANCIAL WARRANTY COULD BE SUBSTANTIALLY INCREASED at that time. As the new operator, I agree to be responsible for posting arty required increase to the financial waaanty for goad cause shown, in a form acceptable to the Board, within 60-days of such notice. Office of Active and Inactive Mines Colorado Geological Survey