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2- <br />ADMINLSTRATIVE INFORMATION: <br />1. Permit Number: <br />2. Operation Name: <br />3. Carrel Permitted Ocerator. <br />Contact Persce: <br />Compaq Name: <br />Ste: <br />city: <br />state: <br />Area Code: <br />4. Soccesaor Ocerator. <br />TO~oq ~ ~v/OdlJflrin GC~I ~io7 ~' <br />~t°o/Yji~ J /~u,~a2c~ <br />Zoio ~o/d i9U~e. <br />%o/orad~; S,o~ s <br />C O zip Coae: B o 9 0 9 <br />~~ 9 Telephone: li 9~' S y 9 Z <br />c~tactPerson: -~DS~,OLj ~ ~ .Dar"vQ~s <br />CompmryName: ~J/Qc~d/' /~~ak ~r/~S~ /~•n~'A~s <br />street: Z 9 2 o Cad a->^ k fs , ~ r. <br />City: ~_ .. .._ _ <br />State: <br />Area Code: <br />IRS Tax ID No. ar Social Security No.: <br />Ce/o~'a'~o S,o~:.~~s <br />C~ ,Zip Code: d ~ '~ ~ T <br />7i 9 Telephone: G s /~ - ~ y7 ~ <br />518 62 /~/~ <br />5. Aoulication Fee: $100.00 for Hard Rock operations; $125.00 for Construction Materials operations <br />M- 2cb2-~~ <br />Make check payable to the Division of Minerals and Geology <br />