2006-02-19_REVISION - M1999022

• Permit No: M1999022
• IBM Index Class Name: Revision
• Doc Date: 2/19/2006
• Doc Name: Transfer of Permit and S.O. application
• From: Eddie Clayton
• To: DMG
• Type & Sequence: SO1
• Media Type: D
• Archive: No

I. ADMINIST1tATIVE INFORMATION:
1. Permit Number:
2. Operation Name:
3. Cmm~t Permittedi
_.__ Contact Person:
Company Name:
Street:
City:
State:
Area Code:
4. Sucmeor Onentor.
Contact Person:
Company Name:
Street:
City:
_ ~ gate:
Area Code:
IRS Tax ID No. or Social Security No.:
5. Aoolicatbn Fee•
_2.
M1999022
ClayS9n Sand & Gravl
Pave Crites
Crites Sand and Gravel
11044 W. Hwy 112
pal Norte _~___~___
_Cslorado Zip Code: 81132
719 _ Telephone: [phone] __
_~ddie Clavton G G

Eddie Clayton E, C~
_Cglorado Zip Code: 81136
719 Telephone: [phone]

$100.00 for Hard Rock operations; S 125.00 for Conshuction Materials operations
Make check payable to the Division of Minerals and Geology