2008-04-23_REVISION - M1977251

• Permit No: M1977251
• 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

I . Permit Number:
2. Operation Name:
2. Current Permitted Operator:
Contact Person:
Company Name:
Sheet:
City:
State:
Area Code:
+. Successor Operator:
Contact Person:
Company Name:
street:
City:
State:
Area Cock:
IRS Tax ID No. or Social Security No
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R D ? ??_r1n_ +?J 1^ i L?`_JJh ?--0 w, fl a „ v
moj& Ave-
C D zip Code: ;90! 10 - l30$
303 telephone: 763 - 30'16
?c?Y'_?? K ?. Aqwe"-S. ?r,
P. 0. 3 pX.- 3 5 'l 7--- --
T/fit Zip Code: _3.7-_-2_-
303 re(rphone:?_3oy_=-
`. :application Fee: `5100.00 for Hard Rock operations; 5125.00 for Consuruction ivlaterials operations
%lake check payable to the Division otReelamation, Mining and Satcty