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<br />_~! <br />,c ~ , <br />II. ADMINISTRATIVE INFORMATION: <br />I. Permit Number: <br />Z. Operation Name: <br />-2- <br />?~~,a lin~.~rht .y 2~.n Gaai4-~PtT' <br />3. - Conent Permitted O tor. <br />C~tact Petson: n <br />CompauyName: ~hiCE'/"ID.nJT P;~,~n)'tY wRD ~F 19SIgJ`[y~ <br />Strect: ~ ~S' ,~.4CDN ~rJb~. Roots 1D9. <br />city: ~Ct >~ <br />Ste: ~ ~aRnD ~ t;o~: ~ a ~ a <br />Area Code: 7/ 4 Teleptrone: e27b - ~,3 ~ ~ <br />4. Saccesaor Ocerator. <br />CantactPersatt c S f~f~it~ CO~k <br />CamparryName: ~NAAJ~ [pO~Ot37E <br />Street 1.~Y622-CrY ~ ~~/~t ~ TG` Q <br />City: /iy T~ Pr47t ~ . <br />state: ... ... ~ro~a Zipcode: Si~a~ <br />area Cow: ,~/ 4 TekphDne: 9y.Z- X32.3 ~/ <br />IILS Tax ID No. or Social Security No.: cJ ~ ~ ,31-~ SSo~ <br />5. Aotrticatbn Fee: $100.00 for Herd Rock operations; $125.00 for Construction Materials operations <br />Make check payable to the Division of NLnerals and Geology <br />