2008-04-23_REVISION - M1984076

• Permit No: M1984076
• IBM Index Class Name: Revision
• Doc Date: 4/23/2008
• Doc Name: SO Application
• Type & Sequence: SO1
• Media Type: D
• Archive: No

ADMINISTRATIVE INFORMATION:
1 . Permit Number:
IA J 1 9 8 q_
. I ) . Operation Name:
3. Current Permitted Operator:
Contact PCrSOTI:
Company Name:
Street:
City:
Slate:
Area Code
4, Successor Ooerato► ;
C ontact Person:
Company Name:
Street:
City:
State:
Area Code:
IRS Tax ID No. or Social Security No.
R 0 Li�oun._&i4_K_
--w-
Zip Code: _$ OI 16 -130$
303 Telephone: 763
80._3 5 7
T IV _Zip Code: _ 2 -
303

Application Fee: S100.00 for Hard Rock operations: $125.00 for Construction Materials operations
Make check payable to the Division of Reclamation, Mining and Satety