2010-07-27_REVISION - M1994117

• Permit No: M1994117
• IBM Index Class Name: REVISION
• Doc Date: 7/27/2010
• Doc Name: SO Application
• From: AGC Resources LLC
• To: DRMS
• Type & Sequence: SO4
• Email Name: ACS
• Email Name: AJW
• Media Type: D
• Archive: No

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II. ADMINISTRATIVE INFORMATION:
1. Permit Number:
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

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