2009-12-17_REVISION - M1982147

• Permit No: M1982147
• IBM Index Class Name: REVISION
• Doc Date: 12/17/2009
• Doc Name: SO Appl.
• From: Adams County Parks
• To: DRMS
• Type & Sequence: SO2
• Email Name: MET
• Media Type: D
• Archive: No

-2-
II.
ADMINISTRATIVE INFORMATION
1. PermitNumber:
AA 617,- 1977
-
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:
IRS Tax ID No. or Social Security No.
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�p Zip Code: 1 606 2,1
Telephone: to yblX�
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Zip Code: (( V
Telephone: ,�j — Born
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