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_ <br />II. ADMINISTRATIVE INFORMATTON: <br />1. Permit Number: <br />/YI- i97~-~~~ u4 <br />2. Operation Name: <br />3. Current Permitted Ocerator: <br />INOA704Rftnt M1rJES <br />Contact Person: / E R RY V w E/Ii-Z <br />Company Name: I NTEY..UkTtoNgL In RRNIVM CUSrF~ <br />G o R Po (LR no ~/ <br />Street: , f OSO / 7 '`~' S~r/~T .fve rE 9S O <br />City. ~ E d V E7L <br />State: LO Zip Code: o2(oS <br />Area Code: 3 0 3 Telephone: 389- ~//(o/ <br />4. Successor Oceratoe <br />Contact Person: ~ E 17 ~ ~~~ <br />Company Name: n ~ ~% _ <br />Street: !"'0 1~ o.(~ /l 1~ <br />City: ~ n rr n G' ~e-C,~' t~n - <br />State: ~~-~p a 4-~n Zip Code: /3-z <br />Area Code: ~ 7 n Telephone: ~ 77- U/ Si.f/ <br />IRS Tae ID No. or Social Seeuriry No.: J ~~- /b - 3 7J <br />S. ApolicationFee: $100.00 for Hard Rack operations; $12.00 for Construction Materials <br />operations <br />Make check payable to the Division of Minerals and Geology <br />