2008-04-23_REVISION - M1993004

• Permit No: M1993004
• IBM Index Class Name: Revision
• Doc Date: 4/23/2008
• Doc Name: SO Application
• Type & Sequence: SO1
• Media Type: D
• Archive: No

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STATE
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DIVISION u/ RECLAMATION, MINING AND SAFETY
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SAFETY
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TRANSFER 0FYCNIMlYAND8FCCES8J0N0FOPERATORS co,,="
APPLICATION FORM
Ronald *.c�m^,
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7lu application Kxx [mnoRrvfPcunhund3mcrskm^[Opummis must c k`v,(4) major parts: l)ox Application Fono;2)
uo Application [cc }) a Porh`noxocc \vxoaxty (a/(ached as part o[/he Application Package) bearing the original notarized
u11,11xm,v[UuSuocSx01 Oumm,; and, 4)a replacement Financial Warranty provided by the Sucmmo,Operator, bearing ail
(MI notarized siunature, To expedite processing, please provide the information in file format and orderdescrihed below,
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\ Oltioll.A: | wish m WAIVE mu}V-dxypmom,ir����muUow/hr
4mluu|/t |bm) Division of Kcrhomovu Niobig and Safety to ,ux|cvhte t Hounoid
Wanno111nqvhemcnts. K you choose Option A you s not submit u
1 inancial Warranty and Pci NVaFF,1111Y Lll)til the Division 110tifieS YOU
of tile Correct alliount of your wal recluirellients.*
2. Oltioti B: | Imo 3O'duy processing time. |
(Initial &Date) hereby s o,qlnccmcm Financial Warranty for the m/ocddknaomunt
as|heFinancial Wanatitv maintained by the cm1-em'I)Cl';1101-. /oncl
that (lie Division of'Reclaination, Minim- and Safety will jecalculutc the
,ecpi^l nz|amuxoo bond oidbill 6 U."n the d:u that the tmw6x is
mmp|cICd und 111, u(IubzJ L1 AN I'± lllLJl) IQ`
u�hv�dmo �,/h,nrwopcom�|u&mr
to he n""noibb kx ymho8 ally nqx`nd iuurnx, m the financial vunnn/y
1 L 010v C2LISC dwxn. ix x fonnaccrpuh|c lo the 8norJ. within N0-daysof'
such notice.
........ --____�_�_-____-_--_'_'__
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