2008-04-23_REVISION - M1978009

• Permit No: M1978009
• 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

ADMINISTRATIVE INFORMATION:
I. Permit Number:

2. Opcration Name:
(:urrent Permitted Operator:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
4. Successor Operator
Contact Person:
Company Name:
St,-eet:
City:
State:
Area Code_
IRS Tax ID No. or Social Security No.
A a c. ee 9
Rob ; n 5? r iL_K '?-o w+ p a
l 8 ?l 5.1c1.-??f??f1• v e .
C O zip code:O! 10 - l30$
303 reiepi,one: -763 - 3014,
MWe
__G e.ner?l_S k ?I eel --
-=?-30.x__ 3 5 14 7 - -
T/V - zip Code:
363 Telephone: 78? 3oye_-,
2 O _o H 5-- s 9_____ __----?
Application Fee: 5100.00 for Hard Rock operatimm 5125.00 for Consn'UCtion Materials operations
Make check payable to the Division of Reclamation, Mining and Safety