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<br />~ . <br /> -°- <br />II. ADNtIi•IISTRATIVE IiVFORN[ATiON: <br />1. Permit Number: <br />2. Operation Name: <br />3. Current Permitted Operator: <br /> Contact Person: <br /> Compaq Name: <br /> Street-. <br /> city. <br /> state: <br /> Area Code: <br />4. Successor Ocerator: <br /> Contact Person: <br /> Company Name: <br /> street. <br /> City: <br /> State: <br />~'~o-r-~cz,~cQ plCw~-~ Q/t,~rr~ <br />~o~,~rAm.~Dn~, n~~~ ~ nc~~QQ, <br />l,~) l ~-r/1~-~ <br />~, n,. A~=~-{- <br />~~e~..rn , ~9n~ r~n 1~ t ~ ~ <br /> <br />~I~rP 11C 4. ~ B~o~a~o <br />Zip Code: l <br />1 Q~ Telephone: ~ ~~ - I o~ ~ ~ 1~`(~j o~~ <br />~~~~~, ~„ Abby. <br />~ of c,; m (uS t~}nc , <br />~= Ic~~~~rcQ.~ ~~ g~aa.~ <br />Zip Code: <br />Area Code: '~~ T' Telepho/ne: - ~ D(4 ~-~-~p21, <br />IRS Tae ID No. or Socia! Security No.: 3/~ -°2a ~'J13 `~ <br />5. AuolicationFee: $100.00 for Hard Rock operations; $125.00 for Construction Materials <br />operations <br />Make check payable to the Ihvision of Minerals and Gcoloe,.y <br />