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2 <br />n. ADMINISTRATIVE INFOWMATION: <br />1. Permit Number: <br />?. Operation Name: <br />Current Permitted Operator: <br />Contact Person: <br />Company Name: <br />Street: <br />City: <br />Slate: <br />Area Code: <br />4. successor Operator: <br />Contact Person: <br />Company Nance: <br />Street: <br />city: <br />Stare: <br />Area Code: <br />IRS Tax ID No, or social Security No.: <br /> <br /> <br />RD?ih¢21_Nri eohl <br />--I? eti vv-- r.. ----- <br />C D _ Zip Code: ?O 16 - 30$ <br />303 Telephone: 7 63 - .30'14? <br />.-_??__ e.n?r?.L._S?• a? 2 r i c_? _L hc- . __ <br />P. o. 0_x1 3 5 4 7- -- <br />-- T/?f - lip Code: .3-7602- <br />---- 6 O <br />303 relepltr?ne: 7$3 -30yrp___ <br />2 D - (n S--q S 6._9 --- <br />Application Fee: `s100.00 for Hard Rock operations; S12i.00 for Construction Materials operations <br />Make check payable to the Division of Reclamation, Nfining and Satety