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uuv~uivileirnu lU:ll AM YKUFIT SYSTEMS <br />... _... <br />IL ADiN1NISTRATIYE INFORMATION: <br />1. PemtitTlumber. <br />~ 2, Operation Name: <br />~ 3. CurrentPerrtdnedOperatar: <br />i <br />i <br />Contact Person: <br />Co+npaAV Name: <br />Strat: <br />City: <br />State <br />Area Code: <br />4. Successor Operator: <br />Contact Parson: <br />Company Name: <br />Street: <br />City: <br />State: <br />Area Codr. <br />FAX No, 719 5"" 9506 <br />•2- <br />P, 006/009 <br />'M l~G~u~`i~ <br />FiaAS CCY~i7 ~.-C~h~ _ <br />~atnl //~yy~~~~tw.t,n- ~ RLCsit~-t~[c~ /~-~cn~~ <br />aysy P, NEVS~,-, <br />GYo.,.//2yy ~~ mil- ~°~ <br />C~o tip Code: OlJ CAS <br />Telephone: ~ 7U a spa - 3~ 3i i <br />~DSP~~'1 Co~tmr-n r I'!d~'~ C/ <br />ayS~/ ~a l;ie,•s~n <br />~ ~ ~. ~ rL~. ~~ <br />IRS Tax m No. ox Social Security No.: <br />Zip Coda ~-~D-~ <br />TelepC~h~on``e• 97y ~ ~~ - ~ ~~ <br />5. Application Fee: $100.00 far Hard Rock operatloos; 5125.00 for Conslmctlon Materials operadom <br />Ma1m check payable to the Division of Reclamation, Mining and Safety <br />