2012-07-05_REVISION - M1983090 ‎(4)‎

• Permit No: M1983090
• IBM Index Class Name: REVISION
• Doc Date: 7/5/2012
• Doc Name: Application
• From: Bestway
• To: DRMS
• Type & Sequence: SO6
• Email Name: ECS
• Media Type: D
• Archive: No

e -
-2_
II. ADMINISTRATIVE INFORMATION:
1. Permit Number: — 96 3 —090
2. Operation Name:
3. Current Permitted Operator:
Contact Person: H V
Company Name:
Street: ao I
City: }M Ll�
State: (n, Zip Code: g 43
Area Code: -V Telephone: �FP - 7d 77
4. Successor Operator:
Contact Person:
Company Name:-
Street:
City:
State: Zip Code:
Area Code: q 7a Telephone: 'e 7�
IRS Tax ID No.or Social Security No.: 84-- b 6 S ?� 49
5. Application Fee: $115.00 for Hard Rock operations;$144.00 for Construction Materials operations
Make check payable to the Division of Reclamation,Mining and Safety