REV105246

• Permit No: M1979166
• IBM Index Class Name: Revision
• Doc Date: 9/29/1997
• Doc Name: TRANSFER OF PERMIT AND SUCCESSION OF OPERATORS APPLICATION FORM
• Type & Sequence: SO3
• Media Type: D
• Archive: No

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ADMINISTRATIVE INFORMATION:
1. Permit Number:
2. Operation Name:
/~ 79 -/Glv
~Q,JNF1-1'S 6RaU£L,
3. Current Permitted Operator:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
RL C3£NN e'~
~E NNE >+I%S ~ ~,< L
~
/y n ,. As o
`7r L~~a
Ca Zip Code: ~/y/~o
Q~~ Telephone: 8'7S/ t/~3S
4. Successor Operator:
Contact Person: EAQL gg,NNc~
Company Name: I~PU~IS.~'S ~iaCIC'~F LJooTL_
Street: /y~O fi/~)' So
City: .I~S'Lo1.9-
State: C~a Zip Code: /`//fir
Area Code: 9'~U Telephone: ~7~,/-~/~'3
IRS Tax ID No. or Social Security No.: X1,3 --SG- 043
5. Application Fee: $100.00
Make check payable to the Division of Minerals and Geology