2009-02-04_REVISION - M1991081

• Permit No: M1991081
• IBM Index Class Name: REVISION
• Doc Date: 2/4/2009
• Doc Name: SO application
• From: Sam Keeling
• To: DRMS
• Type & Sequence: SO1
• Email Name: KAP
• Media Type: D
• Archive: No

II.
-2-
ADMINISTRATIVE INFORMATION.
1. Permit Number: 199 E
2. Operation Name: 1
3. Current Permitted Operator:
Contact Person:
-- - - - Company Name:: - - - - - -
Street:
City:
State:
Area Code:
4. Successor Operator:
Contact Person:
F0_ o k 3(r
Ue??
Co ?0 v Zip Code:
7119 Telephone: _It 2- SS' - 7
ape- .f
(0a_ )PVAj-';?
PO Atli
Loq Ve
Zip Code: Sr oxy-
7 1 !3:, Telephone: 7q2- 55.E 7
Company Name:
Street:
City:
State:
Area Code:
IRS-Tax 1D No. -or-Social Se4 u ?Vo.: -
5. Application Fee: S 115.00 for Hard Rock operations: $144.00 for Construction Materials operations
Make check payable to the Division of Reclamation, Mining and Safety