2009-03-05_REVISION - M1978102 ‎(3)‎

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

Ii. ADMINISTRATIVE INFORMATIQN:
1. Permit Number:
2. Operation Name:
I Current Permitted Operator:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
4. Successor Operator:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
IRS Tax ID No. or Social Security No_
fY I -I % -- 10

S4
©l 0 .
:??.7 I ?• S-erv?te
_? c7 Zip Code: D la 2.O
It)- Telephone: 3 s O- a 37 9
i C \ 1? o?rzs,
1,. w n
I`Uloy W CC !Ov
l7 Zip Code: 8 b to 9 Y
76 _ Telephone: L/ b Z,
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