2003-04-28_REVISION - M1992049

• Permit No: M1992049
• IBM Index Class Name: Revision
• Doc Date: 4/28/2003
• Doc Name: SO Application
• From: Vista Verde Village LLC.
• To: DMG
• Type & Sequence: SO1
• Media Type: D
• Archive: No

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II. ADMINISTRATIVE INFORMATION:
1. Permit Number:
2. Operation Name:
3. Current Permitted Operator.
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
4. Successor Ope.~ator•
Contact Person:
Company Name:
Street:
City:
• State:
Area Code:
IRS Tae ID No. or Social Security No.:

i~-1992-049
Peck Pit
Flick Peck
Peck , Inc.
P.O.EOx 278
(7nrav. Co 87427
Cc• Zip Code; 81427
~.
970 Telephone: [phone]
Keith Zinrtierrian
Vista Verde Village, LLC.
17449 Hwv 550
~c• 814;2
Zip Code:
97.x_ Telephone: [phone]

5' ~~-- n~°a F~~ $100.00 for Hard Roctc operations; $125.00 for Construction Materials
Make check payable to the Division of Minerals and Geology