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<br />-2- <br />II. ADMIlYISTRATIVE INFORMATION: <br />1. Permit Number: <br />2. Operation Name: <br />~'ECE11/ED <br />MAY 0 4 2~ <br />glviaion of Minarab artd Gealag~ <br />-~ypu ~ is `f° ~r<r~/i°~ ~ndArn-,cr~r/n /asBUe~ <br />3. CnrrrM Permitted Operator. <br />- ' ° - - ---Co'ntacfPeisa`n: -` --- - -- - ;dj ~ (/ ~C.~ii~[..!`~ - - .____ _ <br />Company Name: <br />street: ~~~JC ~l~ <br />city: 1_/~NSr C`d <br />State: CIYnT.~Li7r-1 Zip Cade: ~~~ <br />Area Code: Telephone: <br />4. Spaxaaor Operator. <br />Contact Pelson: ~ ~~I/~ f„~h/ ~/~G' <br />Company Name: ~~++ <br />Street: ~~ / T~~'$' <br />City:- - - ~ /~S <br />State: C~C~r~~> Zip Code: -~L~-z[1--- <br />Area Code: , jr73 Telephone: ~j ~, ~, _ S ~o `d <br />II2S Tax ID No. or Social Seciaity No.: rjoZ 3 - 5~~~..47' <br />5. Application Fee: $(00.00 for Herd Rock operations; $125.00 for Construction~vlateriels operations <br />Make check payable to the Division of Minerals and Geology <br />