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<br />-2- <br />II. ADMINISTRATIVE INFORMATION: <br />t. Permit Number: <br />,lVl - 147E •-2~ 2 -C><T <br />2. Operation Name: <br />3. Current Permitted Operator: <br />Contact Person: I~,/1 C- ?~ i.J I-tv II 2 ~i <br />Compa~Name: ;; 77 <br />Street: ~ . ~ ~ I~ O X I Iv <br />City: ~C1 iJP ~ Yer'~" <br />state: r)~ ~O Y~~ r'7 Zip Code: 5?,[ .~ ~ y <br />Area Code: 'S___,~7 y Telephone: li% ~ 7 ` ~ ~ 5 <br />der s o~ - y 8 ~~ ~- ~l y s' o <br />4. Suceessor Operator: <br />Contact Person: <br />Company Name: <br />street: <br />city: <br />State: <br />Area Code: <br />L~ILUM~t ~ , ~Gli;t-~~ <br />5002 SY~~T~7 <br />~ E12C~(Z~~n~ <br />C,D zip Code: ~~ 3~ <br />-3 ~ 3 Telephone: ~ ~`Y - 13 ~ I N <br />II2S Tax ID No. or Social Security No.: ~ - 5 2 - ~$ T~ <br />5. Application Fee: $100.00 for Hard Rock operations; $125.00 for Construction Materials operations <br />Make check payable to the Division of Minerals and Geology <br />