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2- <br />II. <br />]. Permit Number: <br />2. Operation Name: <br />C~fl~~~: <br />3. Current Permitted Ocerator. <br />Contact Person: <br />Company Name: <br />Street: <br />City: <br />State: <br />Area Code: <br />4. Successor Oceratorc <br />Contact Person: <br />Company Neme: <br />sue: <br />City: <br />State: <br />Area Code: <br />IRS Tax ID No. or Social Security No.: <br />~ao~~~9 <br />Q y5aef ~ <br />NN L/ Q <br />L y~J ~ <br />o Zip rode: ~a a ~~ <br />3Q~ Telephone: ~ ~ ~ s <br />~~r~~-N ~~-~~ N _ : ~~, <br />/9~7 ~ ~ ~ 7 <br />.~ 2 ~rr~ <br />Zip Cad-7e: ~~~ <br />9 7o Telephone: SG ~ ~ P z <br />Z 3 - ~j'~- 7s"~~ <br />5. Aoolication Fee: $100.00 for Hard Rock operations; $125.00 for Construction Materials operations <br />Make check payable to the Division of Minerals and Geology <br />