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ll. A1)NIINISTT2A 'lVE IN FOR NIATi0N: <br />L Permit Nwnber: <br /> <br />Z_ Operation Name: <br />Current Permitted Operator: <br />Contact Person: <br />Company Name: <br />Street: <br />City: <br />State: <br />Area Code <br />4. Successor Operator: <br />Contact Person: <br />Company Name: <br />Street: <br />City: <br />stare: <br />Area Code: <br />1RS "fax ID No, or Social Security No. <br />rn l - l 11' <br />`l - <br />Rob?hs?$r? -K C6mp? n)z <br />18 15_ (?t1 ?rfmo??t1. Av_e? <br />-- D eh-vim r.. _..- -- <br />C 0 Zip Code: -&011_Q= /30$ <br />3d3 'felepiionc: 763 - 30'11/ <br />.1-. Y1 <br />14 7 - ---- <br />_T /V Zip Code: _3..-7 o02- <br />303 felephime: ?-3o._y__ <br />303 <br />2 D <br />Application Fee: 'x 100.00 Ibr Hard Rock operations; Sl 25.00 for Construction Materials operations <br />-lake check payable to thc.Division of Reclamation, Mining and Safety