REV106215

• Permit No: M1978342
• IBM Index Class Name: Revision
• Doc Date: 2/19/1998
• Doc Name: TRANSFER OF PERMIT & SUCCESSION OF OPERATORS APPLICATION FORM
• Type & Sequence: SO5
• Media Type: D
• Archive: No

t;
S
~.
II
1I I,
u
-2
ADMINISTRATIVE INFORMATION:
1. Permit Number:
•
~ - ~~ - 3~a
2. Operation Name:
3. Current Permitted Operator:
Contact Person: ~ ~~~
Company Name:
Street:
City:
State:
Area Code:
4. Successor Operator:
~l.LlSo/~ /~/u~
i /,~9 1~~,~ a,/_
~TDK ~~r~
~~~D© ~~~ Zip Code: ~'~~0
/' i
Telephone: ~~~~~
Contact Person: ~O !~~ ~O ~/~ \n
Company Name: . o L ~ A G I-C I1'- /~u /w 6- ~/u C
Street: Po Q o K 3 0 0
City: /I') eNT,POSF
State: ~ U Zip Code: / Z
Area Code: 97o Telephone: o~ S~~ - 07d
IRS Tax ID No. or Social Security No.: Sr 4l~ iyC S 0
r
5. Application Fee: 3100.00
Make check payable to the Division of Minerals and Geology