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1 r <br />i <br />II. <br />~7 <br />AD(tifIlVISTRATIVE INFOR~tATTON: <br />1. Permit Number: ' " ( ~ ~ ~ C? ~ ~ I Z <br />2. Operation Name: Le ~~~~ M 1 Vlf', <br />3. Current Permitted Ooerator: <br />CoatactPerson: '-t/"}7t1'1"i~-r 11~~/l~r"~~"~ L <br />Company Name: ~f~t°~//.1^"~,~~d(A~"r(~j ~5_W~, <br />Street: ~ `I n~ l fl ~ P _ ~ ~ \ /~ . _ ~' ~ ~Q <br />City: ~-~ij/>ItE'./i <br />State: lam) nnZip Code: ~~~ <br />Area Code: ~3 Telephone:`1~~ ` f~~~ <br />4. Successor Ocerator: <br />Contact Person: LL!/'~ L U L O ~~' <br />/ e-FS pew <br />Company Name: ,LOLo%{' ~Ol~I ~~~1G7%~ IhZ~O J <br />street: d,(o /~ l LL S ~ ISO 13~v~J~ <br />City: __,/~P S Q ~~ <br />~~ Zip Code: D ~ <br />State: <br />Area Code: ~~? Telephone: ~.5.~^ 1 ~o <br />IRS Tae ID No. or Social Security No.: ~ 4J - ~ S 3 2 2 `l S <br />~. Apalication Fee: $100.00 for Hazd Rock operations; $125.00 for Construction Materials <br />operations <br />Make check payable to the Division of Minerals and Geology <br />