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2- <br />II. ADMIIVISTRATIVE INFORMATION: <br />1. permit Number: <br />2. Operation Name: <br />3. Current Permitt Ouerator: <br />~d~r ~~+ <br />Contact Person: ~ ~y ~ ~? ~ r~ <br />Company Name: ,~/ /~,a se ['~„ ~ ~ ~ n 7"' <br />Street: ~~~~ l11 1rL~nlrsh. L'~s~ i~ 1 <br />City: ~oloP3 c~o S ,~' z <br />State: [.'., to /'a.c~/~ Zip Code: 8 D R 2 Z <br />Area Code: 7 l ~1 Telephone: ; f - ~ ~-/ O <br />4. Suaesaor Operator: <br />ContaM Person: TD r[ 5,.,-i <br />Company Name: ~OL ~/ ~OU,t ~a to /I <br />Street: ! 9 ~d i~g ~ ~ A~ <br />qty: C v~p~4~D Sar; <br />, ., p ~D <br />State: -~O/fir Zip/1Code: u <br />Area Code: 7 / 9 Telephone: % 73- 3/OO <br />IRS Tax ID No. or Social Security No.: - ~ ~ ' <br />5. Application Fee: $100.00 for Hard Rock operations; $125.00 for Construction Materials operations <br />a/~l~ '~ <br />Make check payable to the Division of Minerals and Geology <br />