2003-12-31_REVISION - M1995038

• Permit No: M1995038
• IBM Index Class Name: Revision
• Doc Date: 12/31/2003
• Doc Name: SO Farmers Construction to Jerry D. Spor
• From: Jerry D. Spor
• To: DMG
• Type & Sequence: SO1
• Media Type: D
• Archive: No

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. II. ADMIMSTRATIVE INFORMATION:
I. Permit Number.
2. Operation Name:
3. Current permitted Ocerator:
Contact Person:
Company Name:
Street:
c;ry:
State:
Area Code:
4. Successor Ocerator:
Contaa Person:
Company Name:
street:
city.
State:
Area Code:
IRS Tae ID No. or Social Security No.:
M / 990 3 ~
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p G°ld Zip Code: ~,Y .
~° Telephone: ~ z- 7 ~ /v 7 4

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Ca 1 o racQ o Zip Code: ~f/~{~3
q 7D Te]cphone: 3 °~ 7- L{,~ d 7
5. Application Fee: $100.00 for Hazd Rock operations; $125.00 for Construction Materials
operations
Make check payable to the Division of Minerals and Geology