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- <br />II. <br />1. Permit Number: <br />2. Operation Name: ~ ~L ~ J~~( f]~ ~ ~' a ~"~c-\~ !1 .~ .' Ifs '(~ <br />3. Curnut Permitted tDoentor. <br />`~- f R -I Lo- D ~ Z <br />Contact Person: ~ ~~, <br />Compmry Name: ~~ / <br />street: ~_~~jgbC ---- <br />City: <br />state: zip code: ~'~ ? f _ <br />Area Code: ~~ Tetephone:.~r~~! ~~, <br />d. Sucoesaor Oaentor. <br />Contact Pers~: <br />Comparry• Name: <br />Street: <br />City: <br />State: <br />Area Code: <br />IItS Tax ID No. or Social Security No. <br />Zip Code: <~~1-~-- <br />4 `cam Telephone: , ~~ <br />5. Aoolicatiou Fee: $1 OQ.00 for Hard Rock operations; $125. for Construction Materials operations <br />Make check payable to the Division of Minerals and Geology <br />