2008-01-23_REVISION - M1997098

• Permit No: M1997098
• IBM Index Class Name: REVISION
• Doc Date: 1/23/2008
• Doc Name: SO application
• From: Flat Top Flagstone, LLC
• To: DRMS
• Type & Sequence: SO2
• Email Name: THM
• Media Type: D
• Archive: No

-2-
it. ADM.IMSTRATIVE INFORMATION:
1. Permit Number:
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.:
NA \?qioqs
-ROL (, art. -e- ?A vAP--
1'9a J \
Qhq1AQDt
W Zip Code:
Telephone: aQd
La S Rq "'Or GA 41+1\0Y 1 Z ?-01
4at MR Ra Js4e)h, LL-
r?LI 5 4 rPC?Yt. ?kl '? nr?i ?e 2,{?
_ C?1 J u nc.?m?
o Zip Code:
9 70 ? Telephone: XbF\/
52) Ob Izv:?)
5. Application Fee: $100.00 for Hard Rock operations; S 125.00 for Construction Materials operations
Make check payable to the Division of Reclamation, Mining and Safety