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- <br />n. <br />t. Permit Number: <br />2. Operation Name: <br />3. Carreat Permitted Operator: <br />Caamct Pelson <br />Company Name: <br />Street <br />City: <br />M ry92-~~~ <br /> <br />`t'CR,I.I. I ~-- I 'I~SL <br />l ~~ .tvn Q <br />d <br />r~~/ <br />sm~: (' c~ ~ cone: 8 0 ~ ~"8 <br />Area Code: Telephone: ~ 7b' 332 5~~8 <br />4. 3uaeseor Operator: <br />Contact Person: ~y~~ ~t ~~ rf/NM T '~~ <br />companyxame: _ f~.~5n rtx ~ SnrLS F~~ ~of <br />street ~;~~o`~ aJc~-~ - ~'o ~d ~~ 3`{34d <br />~;~: r~ 8058 <br />sm~: ~ C> z,;p cane: ~75g <br />Area Cade: qq~ o Te4phone: .3 ~' Sri aJ ~l <br />IRS Tax ID No. or social Sec~aity Na: ! )~ ~ (D ~ ~ ~ <br />5. ApoNatlon Fce: 5100.00 far Hard Rock ope[atiom; 5125.00 for Construction Materials operations <br />Make check payable to the Division of Minerals end Geology <br />