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<br /> -2- <br />H. AD MINISTRATIVE INFORMATION: <br />1. Permit Number: <br />2. Operation Name: <br />3. Current Permitted Operator: <br /> Contact Person: <br /> Cotppany Name: <br /> street:: . <br /> city: <br /> State: <br /> Area Code: <br />4. Successor Ocerator: <br />Contact Person: <br />Company NA.mc: <br />Street: <br />city: <br />state: <br />Area Code: <br />IRS Tax ID No. or Social Secwity No.: <br />m- laa~-oo~ <br />EI"'~lE'RaLj~ V,s~ A E ST~c~-S lam; i <br />("C1. lam- e i eR S c h ReD-~efl- <br />~ rvtERRe_Zj 1/ is r~ GsiA I ~S rn~u;,v~ {,~ i <br />3700 6_ M~~N S;R.eei <br />`r'Ri~iDtiD <br />C fl Zip Code: ~ Qr~S <br />~~ 9 Telephone: 8y~ ~OS30 <br /> <br />SOS S, W At_ aluT ST2~EET <br />T/e,-',N %O~D <br />W zip Code: ~ D S 2 <br />~~ Telephone: ~~F~` y~7D <br />$~-I S(o~12~,(0 <br />5. Application Fee: $100.00 for Herd Rock operations; $125.00 or Construction Materials operations <br />Make check payable to the Division of Minerals and Cleology <br />