2008-04-23_REVISION - M1977252

• Permit No: M1977252
• IBM Index Class Name: REVISION
• Doc Date: 4/23/2008
• Doc Name: SO APPL
• From: General Shale Brick, Inc.
• To: DRMS
• Type & Sequence: SO1
• Email Name: MET
• Media Type: D
• Archive: No

I. ADMINISTRATIVE INFORMATION:
1. Permit Number:
2. Operation Name:
Current Permitted Operator:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
4. Successor Operator:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
IRS Tax ID No. of Social Security No.
x''1_19 7 x..2.5-2 .
P,'6 Y1Ee- r mime,
Marv;h
lSy5.1?c1-?a?'Lme?t? Ve .
C D - Zip code: R0116=13-6s
3o3 relepi,onc: 763 - 30 416
_ Ma Y- V,'Px R, Al I? "r S -Tr,
_ P. 0__ 3 0_?ll 3 5 4 7_--.-
?eh??So+?
Kale- _TAI -Zip Code: _3 7 o
303 releph??„e: ?$3 2 0 -OK 5--y
?. kpplication Fee: 5100.00 for Hard Rock operations: x125.00 for Consu-uction Materials operations
Make check payable to the Division of Reclamation, Nfining and Safety