2008-04-23_REVISION - M1980245

• Permit No: M1980245
• IBM Index Class Name: REVISION
• Doc Date: 4/23/2008
• Doc Name: Submittal of SO Appl
• From: General Shale Brick, Inc.
• To: DRMS
• Type & Sequence: SO1
• Email Name: MET
• Media Type: D
• Archive: No

II. ADMINISTRATIVE INFORMATION:
I. Permit Number:
2- Operation Name:
Current Permitted Operator:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
4. Successor Operator:
Contact person:
Company Name:
Street:
City:
State:
Area Code:
IRS Tax ID No. oi Social Security No.:

Noti bac_K M,
l 8 ?l5.1?1 ___?>f rvt.,fk v e
C o Zip Code: $;0110 -130$
303 Telephone: 783 - .3DAl 6
u Qrs. ?r,
Gen
era.I_?5??
P. O. -Box 3 5 4 7 ---
?1eh?1So+? C. T
TAI - -- 'Lip Code: 376021
.-
303 Telephone:
2 D ,--o q.S_H_?6 9__ ---
Application Fee: S100.00 for Hard Ruck operations: $12>.00 Tor Construction ivlaterials operations
%lake check payable to the Division of Reclamation, Mining and Safety