2007-10-31_REVISION - M1988048

• Permit No: M1988048
• IBM Index Class Name: REVISION
• Doc Date: 10/31/2007
• Doc Name: SO Appl.
• From: L.G. Everist, Incorporated
• To: DRMS
• Type & Sequence: SO1
• Media Type: D
• Archive: No

2-
II. ADMINISTRATIVE INFOR}}1IATION:
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 1D No. or Social Security No.:

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C O Zip Code: (o7
303 Telephone:
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co Zip Code: _(?b
03-Telephone: ZO o-02q7
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5. Application Fee: $100.00 for Hard Rock operations; $1 `Z 00 for Construction Materials operations
Make check payable to the Division of Reclamation, Mining and Safety