2010-01-13_REVISION - M1980131

• Permit No: M1980131
• IBM Index Class Name: REVISION
• Doc Date: 1/13/2010
• Doc Name: SO Application
• From: Elam Construction, Inc.
• To: DRMS
• Type & Sequence: SO2
• Email Name: GRM
• Media Type: D
• Archive: No

-2-
II. ADMINISTRATIVE INFORMATION:
1. Permit Number:
2. Operation Name:
(A 14180- 131 -

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.:
1? ek ?? a S? a G s? -
tr 0
P
101 `I b C Ra1V cj.N
L10 t-bV 0.4-*, A
C-0 Zip Code: OOZI -
3C)3 Telephone: (- S7 - Y00
?J Cry e It /1 ?-3 42
/GGrrf 2t /2 g,6 67'1 &!ii e-
.? s-6 S T r ?c t h c,-s dye .
p Zip Code:
97 O Telephone: -Z V..7. - S- 3 7 0
8y- o` yq3 go
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