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9- <br />II. ADMIMSTRATIVE INFORIytATTON: <br />1. Permit Number: <br />2. Operation Name: <br />3. Current Permitted Operator: <br />Contact Person: <br />Company Name: <br />n~-~9~19_~y~ <br />~~~~~ L~G~ks m,~,t <br /> <br />City: C-i~v~wCr':t~ s~rrhy, S <br />state: CU• Zip code: /6~ <br />Area Code: iJ 7~ Telephone: 7U c/ ~G,7 ~ <br />4. Successor Ocerator: <br />Contact Person: <br />Company Name: <br />Street: <br />City. <br />State: <br />Area Code: <br />~%~~ T:v, sw;~ f <br />~Pt~t~trh~ 1~~~~w5 L~~c <br />art C~;zy,(~o~ <br />~,lt f~~/,~~5 ~ir ~lY: Il'lf. ~c~4,/s 51oh ~ <br />~//~~'~ 17 , rlire~r)~alHC~r ~ GrCK ~,~:.d' <br />~-G=rkJCn ~C:~[ -~ <br />LU. Zip Code: ~~ ~ 3 <br />IRS Tar ID No. or Social Security No.: <br />--lam Telephone: 7~ ~/~ Oj Z~Z <br />5. Aonlication Fee: 0.00 for Hazd Rock operations $125.00 for Construction Materials <br />operations <br />Make check payable to the Division of Minerals and Geology <br />