2003-12-26_REVISION - M2000041

• Permit No: M2000041
• IBM Index Class Name: Revision
• Doc Date: 12/26/2003
• Doc Name: Tsf of permit and S.O. application
• From: CR Evans
• To: DMG
• Type & Sequence: SO2
• Media Type: D
• Archive: No

.
Q. ADMINISTRATIVE iNFORMATIOY:
1. Permit Number.
M- 2n0o- OU1
2. Operation Name:
3. Current Permitted Ocerator:
ContaetPexson: ~1(_. ~er'YQrI~~~-
Company Name: ~ f~tC~r'QP ~~5~-~ ~YIC..
Strut: ~yOD 1 t1Pf~- ~T-kii~ ~12
City ~ n~tP r'
State: ~ Zip Code: ~_
Area Code: ~ Telephone: [phone])
4. Successor Ocerator: (( CC
Contact Person: C- ~ \~~C~ ~ LUQ
CompanyName: ~r--(T1.i~~.
Street ~ n~ (~
City ~ Vl~fl
State: L_J,_l Zip Code: /g~
Area Code: ~ ~ a Telephone: ~/- `i~g
[RS Tae [D No. or Social Security No-: 3 ~ ~ J~y '~ 9 ~ 6
~. A_pplication Fee: SI00.00 for Hard Rock operations; $125.00 for Coastructioa Materials
opcratioos
Make check payable to the Divisioa of Minerals and Gcolog~