Laserfiche WebLink
2- <br />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 'fax 11) No, or Social. Security Na.: <br />M-H77-,SOS <br />rave <br /> <br />Tri- 041d, (3 rc.vo? <br />''P0 9d X S-94 <br />ft0)A k;55 <br />CD Zip Code: 8/A//g <br />9 70 Telephone: 8 7.2- 3 S /Ys <br />S-el<Mdnd <br />aacesli Su /eu?, 1nG A;4 06,14 (,p.+Dcn%n a?/`?lK v^?r <br />Po Qox 36by <br />6te.01 1 c/dncLIA <br />Co Zip Code: ?1S0r2 <br />9?b --- Telephone: ----,Z j/Y- N900 - -- <br />_ ............................ y„- o y ti 9-53 ?.................... <br />Application Fee: $I 1;.,0 t for Hard Rock operations; $144.00 for Construction Materials operations <br />Make check payable to the Division of Reclamation, Mining and Safety