2007-06-26_REVISION - M1987088

• Permit No: M1987088
• IBM Index Class Name: Revision
• Doc Date: 6/26/2007
• Doc Name: SO application form
• From: Hubbs III, LLC
• To: DRMS
• Type & Sequence: SO4
• Email Name: KAP
• Media Type: D
• Archive: No

-2-
II. ADMINISTRATIVE INFORMATION:
1. Permit Number:
/14-/197- Q8?'
2. operation Name:
3. 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. or Social Security No.:
e---
84 IL4 /
f QQ ?
Zip Code:
_ Telephone:
Zip Code: ??-
- Telephone•~ ?-??X
5. Application Fee: $100.00 for Hard Rock operations; $ I25.00 for Construction Materials operations
Make check payable to the Division of Reclamation, Mining and Safety