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- <br />II. <br />ADMINISTRATIVE INFORMATION: <br />1. Permit Number: <br />~,5~1- <br /> <br />2. Operation Name: <br />3. Current Permitted Ocerator. <br />Contact Person: J-t1 M E S `~ K2A k ~( <br />compairy Name: ,~ ~ m E.s C~ ~ ~cc ~C ~ F J Ktz A Icc ~ <br />Street: ~ ° Cj 0 K rl 3 ~ <br />City. ~ E ~ IC n c~'o ~ <br />State: C-~~o Cl-A~o o Zip Code: o .S <br />Area Code: G' `l o Telephone: S (v B - `1 `( 0 J <br />4. <br />Contact P ~ F. (~ / ~T i ~~' ~ r.3'~'a v~ <br />compauy ame: {`~~ ~~, ~ ~ n.i r, s Sa ~ ~ r G!C A yc <br />street: ~ d 1.3 e ~c (eZ a 8 <br />city: ~ d ~ c Io,~~ <br />S C~~m lea Zip Code: SAS `fS <br />ea Cade: ~ ~ o Telephone: ~ (-r' ~ ~ Y O <br />IIt$ Tae ID No. or 5acial Security No.: ~(~ ~ `~ ~ ( ~ <br />5. A~„ptication Fee: $100.00 for Hard Rock operations; $125.00 for Construction Materials <br />operations <br />Make check payable to the Division of Minerals and Geology <br />