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<br />~. <br />II. <br />ADhiIMSTRATIVE INFOIL'~tAT1ON: <br />9~ 1. Permit Number: /'?- 9s'-!~ 9 5 <br />X 2. Operation Name: ,~ ~`ru lat ~ i4 (.. r.Ja .r ~ i ~- <br />y~3. Current Permitted Operator: <br />Contact Person: L'laa/(cs ~. M=L'u.Ile L. <br />Company Name: ~/ /tea so Gmu,,~~ J 13~R I . a ~ f~ „.s~ol'la l.'v `. <br />Street 3<f CEO AI. MzCP~r ~ ~'{~'r_1 ~A~ <br />City: Gm~o 1~ /' ~~ ~ t <br />State: ~rlln/'.2~tJ Zip Code: ~D 9 Z Z <br />Area Code: '? 19 Telephone: F LG~ -!o ~ Lo D <br />4. Successor Operator: <br />Contact Person: /T~NR~ _ /7~ _~~~l~~E <br />Company Name: ,SG c(LGf~. "~E~}~e,/V~ <br />str«t: 5'1 D Cl~1~DGl STl2EE7.T ~X3~g <br />city: S/,Cla L.~ <br />State: C D Zip Coe~d//e: <br />Area Code: ~~ Tefeplt//o__ne: -~/Y'~ a2,3 9~ <br />IRS TaY ID No. or Social Security No.: S~ a- - OZ/o ' 7!O ~~_ <br />~. Application Fee: $100.00 for Hazd Rock operatio s; $125.00 r Construction Materials <br />operations <br />Make check payable to the Division of Minerals and Geology <br />