2005-04-25_REVISION - M1983164

• Permit No: M1983164
• IBM Index Class Name: Revision
• Doc Date: 4/25/2005
• Doc Name: Application
• From: George F. Gallegos
• To: DMG
• Type & Sequence: SO2
• Media Type: D
• Archive: No

RF~~.gV~D
_, _ MAY p g ?005
II. ADMINISTRATIVE INFORMATION: DivisionarM~~efdaan~geplogy
I. Permit Number:
2. Operation Name:
3. Current Permitted Operator:
Contact Person: >~ ^~E-r~~~lE~`~ ~ ~ p ~(
Company Name: ~Qs~(? `~ ~~ ~ Icc~61~P~7~`/~
Strcet: ?-~ ~ ~ ~~/ ((xJ w~'f
City: ~~~ ~7
State: t~c~ Zip Code: ~ (~ /
Area Cade: ~_ Telephone: ,3 ~ f~~ S
4. Successor Ocerator:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
IRS Tax ID No. or Social Security No.:
Zip Code:
Telephone:
5. Applica6onFee: $100.00 for Hard Rock operations; $125.00 for- Construction Materials
operations
Make check payable to the Division of Minerals and Creology