REV06647

• Permit No: M1989120
• IBM Index Class Name: Revision
• Doc Date: 7/19/2001
• Doc Name: TRANSFER OF PERMIT & SUCCESSION OF OPERATORS APPLICATION FORM
• Type & Sequence: SO3
• Media Type: D
• Archive: No

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II. ADMINISTRATIVE INFORMATTON;
1. Permit Ntunber:

M~~-lZo
2. Operation Name:
3. Current Permitted Operator:
aQ~L yaLL_T `cam -
Contact Person: ~ n->!'r' i C k WCi t'G~ .
Company Name: CLZ ~"~ A~ ~~C~2//fl , ti<..
Street: x(,05 5 ~l(~~ ~~".
cih~: i~rrk~~~wr~~:~.
State: L.U Zip Code: i~~~S
Area Code: ~ D ~ Telephone: q ~C 5 - 10 ld
4. Successor Operator:
Contact Person: ~~ L~ IN!1I'l~C,
Company Name: Aonr'P!~'~-fC, ~dll5'1-rIPS - WCP., .J.X1G,
V
Street:
City: `~LLmL''
State: Zip Code:
Area Code: Telephone:
IRS Tar ID No. or Social Security No.: S34 - Con - Q ~t-}p
S. .4palication Fee: $100.00 for Hard Rock operations; $125.00 for Construction Materials
operations
Mahe check payable to the Division of Minerals and Geology