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. ` <br />•z- <br />II. <br />]. Pe~mitNumber: <br />2. Operation Name: <br />3. Current Pesmttted Operator. <br />~ -19g3 -159 <br /> <br />Contact Person: t~- rn r K//u:~nG ~a~rrflf..~ <br />Compa~Name: ~AI'lY1PJ' l.ll/Id1<fLtU~iO/1 <br />stns: ~~ d~ox. ~9 <br />city: ~/n~ ~.cL v a I'mo`` <br />State: nlA LD rA,cLU Zip Code: , /$ I~3I <br />Ana Code: -I ~~ Telephoner ~ 7~ ~ ~e <br />4. Successor Ocersdor. <br />contact Person: ~ ;~ 5 U~ ~f4p ~. <br />Campemy Name: <br />Strcet.• a p <br />City. _ ~ I.C~ <br />Statc: c.~ iip ~: yay <br />Area Code: ~ ~ 6 Telephone: ,~~ l -SQJ~ <br />II2S Tax ID No. ar Sociel Security No.: <br />5. Application Fce: $100.1)0 far Sm~d Rock operations; $125.00 far Construction Materials operations <br />Make check payable in the Division of Minerals and Geology <br />