REV01305

• Permit No: M1977436
• IBM Index Class Name: Revision
• Doc Date: 3/20/2001
• Doc Name: TRANSFER OF PERMIT & SUCCESSION OF OPERATORS APPLICATION FORM
• Type & Sequence: SO4
• Media Type: D
• Archive: No

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II. ADMINISTRATIVE INFORMATION:
1. Permit Number:
C~

2. Operation Name:
3. Current Permitted Ocerator:
~r~~~ :~~h MI n~ -
Contact Person: ~ -~'r'~ C k W/A J-G~.
Company Name: CA ~"~ A~ ~~C~r41.f!fl ,Tir'~L.
Street: ~ (Q OS 5 . ie ll er J`~-.
city: La k~'Ll/~7~
State: ~ Zip Code: ~~35
Area Code: ~,D.~i Telephone: ~~~ - ~O ~d
4. Successor Ocerator:
Contact Person: ~t'n/2.{-r i Lk tiN!1 rl~C.
Company Name: h-~]rP~'fCJ ~~';!1~4f-rIPS-WC-P.,TnC.,
v
Sveet:
City: `.~0-fie'
State: Zip Code
Area Code: Telephone:
IRS Tai ID No. or Social Security No.: ~4 - Con - 4' i4~
5. Application Fee: $100.00 for Hard Rock operations; $125.00 for Construction Materials
operations
Make check payable to the Divisiop of hfinerals and Geology