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. <br />R <br />1 <br />f <br />II. <br />.~_ <br />ADhIINISTRATIVE INFOELtitAT, iON: <br />I. Permit Number: <br />2. Operation Name: <br />3. Current Permitted Operator: <br />~~ -1 `l - 1 ~- ~ <br />L^`<o ~ 5 Q u ~~~Y <br />Contact Person: ~~~ G~ 1 ~ ~O ~--/~G/~ <br />I <br />Compa~Name: ~6LO.~NS ~N0~51TL ~~NtNG~ ~~ <br />street: bozo T~-l~un_ Srt Su.~ A- <br />City. ~,.r,N c,~no~J`T <br />State: Colo Zip Code: ~, <br />Area Cade: ~ bpi Telephone: ~OZ - d~d8 <br />4. Successor Ocerator: <br />Contact Person: ~~/•~'f ~! ~( f~~' D <br />Company Name: /-t[xG>;~.ATE IN~7U5 I RIGS ^ wCle~-t/~ <br />Street: ?7~©~ S ~ =LLF,2~ SI <br />City. l~+-l~(~>OOf) . <br />State: ~ ~ Zip Code: ~ Z3~ <br />Area Code: 30"'~ Telephone: ~~~ - S 3 2 7 <br />IRS Tar ID No. or Social Security No.: ~~ - ©~ d `T' ~~!"b <br />5. Anolication Fee: $100.00 for Hard Rock operations; $125.00 for Construction Materials <br />operations <br />Make check payable to the Division of Minerals and Creology <br />