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~- <br />II. ADMINISTRATIVE INFORMATION: <br />I. Permit Number: <br />L~1' f of ~C~ ' 2 2~ <br />2. Operation Name: <br />3. Current Permitted Ocerator. <br />~~ ~ ~`fi <br />Contact Persoa: ~~AA__, ~~~ ~ , n <br />Company Name: !SL(b~ Ceb t\Pn~n ,~M~n :,. L"n c, <br />Street: ~~~ ~ c<~z~- z~a 7 <br />Crty. .~ )c A n ~-...~Qp <br />state: ~} Zip ~: g(~ ~ <br />Area Code: ~ U Telephone: 2`~ I- Z l 7 <br />4. Successor Ocera~; <br />Contact Person: <br />Company Name: <br />StrCe<: <br />city: <br />state: <br />Area Code: <br />IRS TaY ID No. or Social Security No.: <br />;, _ ~ ~ ' <br />~~ . <br />C~CG~eo-~o~Ct` S t-~ Gera ~ (J, L~ e , D C3 (~ <br />~r U i-CrR N ~.S t /'l.(G'~n ~ c t.5 <br />P~ o, ~~x z>v ~ <br />-Q ,,~'y 7rp code: [ v ~ <br />.-L_LSL_ Telephone: Z`f ~ ~ Zl ~ 2 <br />5. A~nlication Fee: $100.00 for Hard Rock operations; $125.00 for Construction Materials <br />operations <br />Make check payable to the Division of Minerals and Geology ' <br />