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~- <br />II. ADMINISTRATIVE INFORMATION: <br />1. Permit Number: <br />,n ~~- 07~ <br />2. Operation Name: <br />1 o-~S~ ~~ Chu a~ <br />3. Current Permitted Operator: <br />Contact Person: <br /> <br />Company Name <br />Street: Y/ s5 yVw,, Ie <br />State: (r0 Zip Code: 8'163 7 <br />Alta Code: 9 7o Telephone:.s o~ ~/ - l %~~ <br />4. Successor Operator: <br />Contact Person: ~,v1 ~ ~'n ~- ~~ ~ f/'{~Rvn/cr <br />Company Name: i//9iruE L~/duei-ietrrS .~{st/G <br />Street: _ _ _ '//SS- r~,~ti G <br />City: ~9~~orsu n.' ~~ <br />State: ~ zip Code: SI63'J <br />Area Code: ~ 20 Telephone: S a ~ '~ 7; 3 <br />IRS Tac ID No. or Social Security No.: ~ y- ~ ~ f~~-3 o p <br />5. Aoalication 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 />