2009-03-05_REVISION - M1978102

• Permit No: M1978102
• IBM Index Class Name: REVISION
• Doc Date: 3/5/2009
• Doc Name: SO Appl.
• From: Shipps Farms LP.
• To: DRMS
• Type & Sequence: SO1
• Email Name: JLE
• Media Type: D
• Archive: No

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11. ADMINI§TRATIVE 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:
MS Tax 1D No. or Social Security No.
M IQ `Z 10)
S XA l P I >J 117-
C G&. ink ; V?--
0 C7 Zip Code: ` d b 2 O
!?I; D Telephone: °3 5 ©- 2 3-7 Ij
I I10(.1 w C V-?L JOo
C7 Zip Code: g b
'7 Telephone:
5. Aimlication Fee: $115.00 for Hard Bock operations; $144.00 for Construction Materials operations
Make check payable to the Division of Reclamation, Mining and Safety
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