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~ <br />[I. ADMTIVTSTI2ATIVE INFORMATION: <br />1. Permit Number: ~ ' ~ [O(j D 0.30 <br />2. Operation Name: f~ ~ R Z - D iC. O ~i'a v e ~ /~ G <br />3. Current Pernritted Ocerator. <br />Contact Person <br />Company Narise: A~(p Q S - D L. 4 .L L P_ <br />Street: /-. t7. Q o R 3 6 7 <br />City: Q o v ~': a%E' L° O g // 'Z 2. <br />i <br />State: Zip Code: <br />Area Code: Telephone: <br />4. Successor Operator: <br />Contact Person; /ya r o ~eX F. E~rw.y~ <br />Company Name: .~ ~a,m Ce~.sJ'f"nW~T~ar~ .~" C. <br />Street: S.J-6 S ~,. w t h -~ r s Ave. <br />City: ~7 ra..r~ .J ,, ,s a Ti o .~. <br />State: C OLipCode: '~/S'O~ <br />Area Code: 9 7O 'telephone: .Z ~/.? - S3 7 U <br />IRS Tax ID No. or Socia! Security No.: 8 y ' O t/ B y ~ 8 0 <br />1Yy <br />5. Application Fee: 5100.00 for Hard Kock operations; $Y2Sb0 for Construction Materials operations <br />Make check payable to the Division of Reclamation, Mining and Safety <br />