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F.. <br />II. <br />2- <br />ADMINISTRATIVE INFORMATION: j q ~f ~f ,~/// <br />1. Permit Number. ~ - / r / CJ ~ ~ ~ O~ (,.~ G V <br />2. Opcratioa Name: /' V 1 fi i1 0 G ~ f~-/Yt / t l ; n C <br />3. Current Permitted Ocerator. <br />contact Person: ~~ ~ I ~ 1 .R-r'wl ~ kr n e ,T <br />Conway Name: <br />street: `J~ D~ ,~ ~ u:'1G~ ~" ~~ k' <br />/' <br />city: ~/L~~ E/2.Co 2F ~ r( <br />State: (~ I n zip code: D ~~ <br />Area Code: _ Telephone: ~=~ 3 ~ f <br />4. Sncceseor Ocentor• <br />contact Person <br />Company Nam: <br />street. <br />city: <br />stare: <br />Area Code: <br />IRS Tax ID No. or Social Security No.: <br />1 V ).t tit: rn L. o ~-- ~ L° <br />/D 77/ - 3o2D~ %<o~ <br />HorCNk~SS <br />~a /D zip6corn~e: r~ > ~1~9,q. <br />9~o Telephone: ~1 / ~ ` ~v~ 7"/ <br />Zd- ~p 73 732- <br />5. AnotlcaHoo Fee: $100.00 for Hard Rock operations; $125.00 for Construction Materials operations <br />Make check payable to the Division of Reclamation, Mining and Safety <br />