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~_ <br />II. AD~IIlYISTRATIVE INFO&'~tATTON: <br />I, Permit Number: <br />2. Operation Name: <br />3. Current Pernutted Operator: <br /> Contact Person: <br /> Company Name: <br /> Street: <br /> City. <br /> State: <br /> Area Code: <br />4. Successor Operator: <br /> Contact Person: <br /> Company Name: <br /> street: <br /> City- <br /> State: <br /> Area Code: <br /> IRS TaY ID o. or Social Security No.: <br /> <br />52I .O,~t~ I ~~ <br />~_ Zip C-otde: ~ ~ZZ <br />Telephone:.Zg" ! ' .2j b,L <br />~11 EtCSYI+~-1 <br />~~t ohs l Inc. <br />X1099 t-l_)lA~"~oa.d sz <br />~ce~-~'~~ 1~1 <br />Co1~iQ.A-ny Zip Cade: n 2Z <br />~O Telephone: ~~ - 4 533 <br />~8~1 -085~2oa <br />~. A lic on Fee: $100.00 for Hard Rock operations; $125.60 for Construction Materials <br />operations <br />M „check payable to the Division of Minerals and Geology <br />