2004-09-16_REVISION - M1981057

• Permit No: M1981057
• IBM Index Class Name: Revision
• Doc Date: 9/16/2004
• Doc Name: Tsf of permit and S.O. application
• From: Sprague Stone
• To: DMG
• Type & Sequence: SO2
• Media Type: D
• Archive: No

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II.
1, Permit Number.
2. Operation Name:
3. Current Permitted Operator.
Contact Person:
Company Name:
street:
city:
Stale:
Area Code:
4. Sacceasor Operator:
~!- 191- OS-?
~~~ ~~ ,P~d ~ yo~,s
--o
1
~97S N~° ~ ~ 2`7
I,A~ Zip Code: 0 ~S3
Telephone: ~0 ~9 3 - ~ 9 a
Contact Person: lYl 11-7T .S~r ~3 ~~
Compaq Name: SY~ rpq v F 5 fnN~
sit: Ili sQ~~~,.~ /~v~
city: L~ ~ ~ ~ o v ~ q
State: Zip Code: ~ r~ 3
Atea Code: 7~p Te~le/,phone: 532- ~ Z y ~/
1R5 Tax ID No. or Social Security No.: 0 ~ r ~~O Y~l'~~
5. Applicatiop Fee: $ ]00.00 for Hard Rock operations; $125.00 for Construction Materials operaticns
Make check payable to the Division of Minerals and Geology