2009-06-25_REVISION - M1997089

• Permit No: M1997089
• IBM Index Class Name: REVISION
• Doc Date: 6/25/2009
• Doc Name: Submittal of inadequate SO application & PW
• From: DRMS
• To: Stone Sand & Gravel, LLC
• Type & Sequence: SO1
• Email Name: WHE
• Media Type: D
• Archive: No

2-
II. ADMINISTRATIVE INFORMATION:
1. Permit Number:
2. Operation Name:
3. Current Permitted Operator:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
pill
(? ® --Zip C'ode:
vl?)L Telephone:
4. Successor Operator:
Contact Person:
Company Name:
Street: 11? ` ?r9
City:
State: Zip Code:
Area Code: Z Telephone:
IRS Tax ID No. or Social Security No.:
5. Application Fee: $115.00 for Hard Rock operations; $144.00 for Construction Materials operations
Make check payable to the Division of Reclamation, Mining and Safety