2007-08-30_REVISION - M1984041

• Permit No: M1984041
• IBM Index Class Name: Revision
• Doc Date: 8/30/2007
• Doc Name: Application form
• From: American Gypsum Company
• To: DRMS
• Type & Sequence: SO4
• Media Type: D
• Archive: No

-2-
II. ADMINISTRATIVE INFORMATION:
1. Permit Nutnber:
2. Operation Name:
3. Current Permitted Ocerator:
Contact Person:
Corrglany Name:
Street:
Clty:
state:
Area Code:
4. Successor Operator:
Conffict Person:
Company Name:
Street
Illy:
SffitC:
Area Code:
IRS Tax [D No. or Social Security No.:
~aQla-(:~ an llm Mine
Stephen A Onorofak;a
Z R'I~T, Vii- 7~ n.-.... 1, n 1 a _ .. ~ n O
rccoc ar0a .. .,c i vv
~,-x z;p case: ~ ~ a i ~
~~_ Telephone: `~.~_g ~~98
(: nDSII RI
('(7 Zlp COde: ~,~,~
~-~_ Telephone:
RSQ311 gyS
5. Apptkatlon Fee: $100.00 for Hard Rock operetions; S 125.00 for Constntction Materials operetiore
Make check payable to the Division of Reclamadop, Mining and Safety