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z- <br />II. ADMINISTRATIVE INFORMATION: <br />1. Petmit Number: lv\ ~' ~ 1 , 1 - e'Z T <br />2. Operation Name: Cn /L (d R~ ~ Gt, r r Y <br />3. CarreatFermhtedOcerator. <br />c~tant Person: ~o b S `~'. ~R S A R`{ <br />Compaay Name: ~ - P G Y PTV ~ for P <br />street: i~ 0 1 p i ~.+r b. s~ ~.c ~' <br />city: __ ~p y~~~Q .,~i~, <br />state: G a V zp code: fl $ o Z <br />Ana Coae: STo Z Telephone: ~ 3 S - ~ ~ / ! ~iC~. Z 19 <br />4. Sumaaor Operator. <br />cant~tPer~: $~~ S H A S A R Y <br />comparryxame: Pa A ~ N ~-e~ ~. ~ rc es i 1..L G <br />street: '~ `1 t' ~ ~ .err O V ~]-s. h r , <br />city: 'D ~~ nl1R c" !~ <br />State: zip Coax: 9 z g f,Z7 <br />Ana Code: ~_ Telephone: '? 7 ~ - 5 ~ 9 ~ <br />IItS Tax ID No. or Social Security No <br />5. Applkatbp Fg: SI00.00 for Hard Rock operations; S 125.00 for Construction Materials operations <br />Make check payable ro the Division of Minerals and Geology <br />