2011-03-14_REVISION - M1991037 ‎(4)‎

• Permit No: M1991037
• IBM Index Class Name: REVISION
• Doc Date: 3/14/2011
• Doc Name: SO Appl.
• From: Destiny Mining LLC
• To: DRMS
• Type & Sequence: SO3
• Email Name: DB2
• Email Name: AJW
• Media Type: D
• Archive: No

-2-
II. ADMINISTRATIVE INFORMATION:
1. Permit Number:
,o&j - r?/-C3`7
2. Operation Name:
3. Current Permitted Operator:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
4. Successor Operator:
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.gJVT IyOdY xih o+ T/•K
/y11d??9j2c H T®??? Co -d V0
P© ,t34x ?.?o ?.1d
L?TTLE7 oi? CO -
C-CL,Lp Zip Code: i!l / rvL
Telephone: C S° a
'eg
Contact Person: ady49
Company Name: A GST.? d-"Z //LJl1 tiZ L.>`r?
Street: /00 A 4A 1S 13A1
City: r'04-0 sy'2s
State: Co e-a Zip Code: ?O -! }
Area Code: 71CI Telephone: 17CZ19 mlaZq6
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