2005-12-09_REVISION - M1995009 ‎(2)‎

• Permit No: M1995009
• IBM Index Class Name: Revision
• Doc Date: 12/9/2005
• Doc Name: SO Submittal
• From: Dorman Brothers LLC
• To: DMG
• Type & Sequence: SO2
• Media Type: D
• Archive: No

2_
II.
1. Permit Number:
2. Operation Name:
3. Current Permitted Operator:
Contact Person:
Company Nana:
Street:
City:
State:
Area Code:
4. Successor Ocerator:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
IRS Tax ID No. or Social Security No.:
M-95-009
Fasse Pit
Ray Leahy
Fisher Sand ~ Gravel Company
P.O. Box 1120
Spearfish
South Dakota Zip Code: 57783
605 Telephone: [phone]
Michael B. Dorman
Dorman Brothers LLC
19230 County Rd. 55
Burlington
Colorado Zip Code: 80807
71 9 Telephone: [phone]

5. Aoollcatioo Fee: $100.00 for Hard Rock operations; $125.00 for Conshuction Materials operations
Make check payable to the Division of Minerals and Geology