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REV91141
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REV91141
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Entry Properties
Last modified
8/25/2016 3:12:44 AM
Creation date
11/21/2007 11:09:18 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1980049
IBM Index Class Name
Revision
Doc Date
2/20/2001
Doc Name
TRANSFER OF PERMIT & SUCCESSION OF OPERATORS APPLICATION FORM
Type & Sequence
SO1
Media Type
D
Archive
No
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' <br />-°- <br />II. ADMIMSTRATIVE INFORhL4TiON: <br />I . Permit Number: <br /> <br />M -190 - oy9 <br />2. Operation Name: <br />3. Current Permitted Operator: <br />Mo ~T (+.ralle/ ~i <br />Contact Person: _~ i C~nrc(X~~ ~ l~`,'fAO f'f <br />Company Name: g )~n^~I ~ J",o~nT fn~ <br />Street: .~ q 7~ C l4ar Farfc Rd - <br />City: Ma {~P~1y <br />State: ~~ to rac~0 Zip Code: /yam <br />Area Code: q 7D Telephone: 9~ ~' 733 <br />4. Successor Operator: <br />Contact Person: ~onalcQ R. }7IQr <br />CompanyAfame: 2~ono/cQ R. ~irr//' ~ 11 <br />Street: n// ~l~ t_~Par ~nrF~ t><Oad <br />City: ` r^aw/I Q"n r cal <br />State: ~d~r'vcYQ Zip Code: ~~y~Sp <br />Area Code: 9 7th Telephone: ~~ ~ -,~~ 9 / <br />IRS Tar (D No. or Social Security No.: .S©9 - y y - ~ / / R <br />5. AaolicationFee: SI00.00 for Hazd Rock operations; $125.00 for Construction Materials <br />operations <br />Make check payable to the Division of Minerals and Geology <br />
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