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