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,_ <br />fl. AUh11VISTRATIVEL~FORAtAT10N: <br />I. PrmutNamher. m- 1~~?- a13 _ <br />2. (.]peration Name' ~_~._ I f <br />3. Current Permitted Optrgtor. <br />Contact Person: { RONh R S E . ~ t y,ba ~ r <br />Company Name: ~ ) <br />O ~Tl1C. <br />Y~'~C __ <br />Street O <br />Q. AOk ~S~ <br />~ <br /> ~~ <br />statr: ~/ An ~o : 8/ 06 7 <br />z;pcn <br />ar <br />Area Code: 7 ~ 'Telephone: ~ <br />/ <br />~S7 - 7'!~6 <br />4. Successor Operator. ,t,~ <br />Contact Peron: ,{/•tI KQ- ~QCDO501.7 <br />Company Narne: riot Rivers Rwneh Ca~i-Fk Feed:rvr< I.LC <br />Street. ?~~8 U S~ rl..~y__S ~ <br />Gify: L ~rv~l3 C <br />state: CA 'Lip Code: ~I OS 2 <br />Arca Code: 7~ Teephone: "8 a 9- '>' S~ / <br />IRS Tax ID Nn. nr Social Serenity No.: IAA[ I Q._-_ a L_ ~~ ~ 16 Q /__ _""__" <br />5. Aoollcation Fee: S 100.00 for Hard Rock operations; S 125.00 for Conshuction Materials operarions <br />Make check payahlr to the Divisan of Rcclnmalioq Afinmg and Safety <br />