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~- <br />11. ADMINISTRATIVE INFORMATION: <br />1. Permit Number: <br />-zoos- Is~l <br />2. Operation Name: <br />3. Current Permitted Operator: <br /> <br />Contact Person: F1L'~D ~o t l ~~.~ <br />Company Name: ,~,~ ~ ~-`-~ N ~ <br />Street: QO C'~O X ~ S U <br />city: ~oy:2 c a o 1 k ,/ <br />State: Cc~ Zip Code: ~ ~ 3 Z ~/ <br />Area Code: ~ Telephone; Ip 7 7 ` a~ 7 ~p <br />4. Successor Ooerator: <br />Contact Person:S~ ~l ~ ~, ,n 4(`~ (~ S <br />Company Name: (~t'Y1 r,~r~~ ~ (lS ~T01~ Q l c3 ~~(' <br />Street: -NYC) E"~AY ~ <br />City: 1~/~c~/~J Jl L'h o4 ~ Q <br />State: _ I ,V Zip Code: 0 ~ 3p 2 ~"' <br />Area Code: ~u~// _ Telephone: ~ ~ 7 - ~ O 3 U <br />IRS TaY ID No. or Soda! Security No.: _ / t0 - 6 5 U ~ ~ ~~/ <br />5. Application Fee: $100.00 for Hazd Rock operations; $125.00 for Construction Materials <br />operations <br />Make check payable to the Division of Minerals and Geology <br />