REV105536

• Permit No: M1999021
• IBM Index Class Name: Revision
• Doc Date: 3/20/2001
• Doc Name: TRANSFER OF PERMIT AND SUCCESSION OF OPERATORS APPLICATION FORM
• Type & Sequence: SO2
• Media Type: D
• Archive: No

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[I. ADMIMSTRATIVE INFORMATION:
1. Permit Number:
u

2. Operation Name:
3. Current Permitted Operator:
~~~an~ er ~~rwK
Contact Person: ~2-ti!"!'i L ~' W a- -
Company Name: CQ ~`'[ A~ n (n ~ ~ ~ ,
Street: ~r~o5 5 e[fer- 5`f".
city: n z°rA~ %~..
State: L4J Zip Code: KI~ti3S
Area Code: ~ D ~ Telephone: Q ~'~ - [ ~ id
4. Successor Operator:
Contact Person: ~~-r~L~ ~N!1r0~..
Company Name: A~~r~yryjliS~TlPS- SCR, ~C,
Street:
City: SamC''
State: Zip Code:
Area Code: Telephone:
IRS Tar 1D No. or Social Security No.: R4- C~ - 4?~O
~. Application Fee: $100.00 for Hazd Rock operations; $125.00 for Constnrction Materials
operations
' Make check payable to the Divisiop of Minerals and Geoloe.~Y