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4 <br />II. ADMINISTRATIVE INFORMATION: <br />1. Permit Number: <br />2. Operation Name: <br />3. 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 />State: <br />Area Code: <br />IRS Tax 11) No. or Social Security No, <br />(v1- N0113-oy7 <br />1 Lkvv-k(:D,, Cc C' '-'t Y <br />tA CA'- V- l- <br />U V\? (D.- <br />155. <br />C? <br />9-70 Telephor <br />S V\, c'- L,--) <br />S?? f V <br />S I C\,- Lf , S f <br />_ Zip Code: 1? 0 - SS <br />,e: Z- S-718 <br />I`C C? (? t? 5 0 to Ems. 9' SoviS EeeetIdf, nic. <br />,3t4-3&0 Ce, ?2 - PbRey 3Z j <br />Cn Zip Code: (96] SE <br />70 Telephoner <br />g 1 __-. <br />5. ARo ication Fee: $115.00 for Hard Rock operations; $144.00 for Construction Materials operations <br />Make check payable to the Division of Reclamation, Mining and Safety