2008-04-23_REVISION - M1978014

• Permit No: M1978014
• IBM Index Class Name: Revision
• Doc Date: 4/23/2008
• Doc Name: SO Application
• Type & Sequence: SO1
• Media Type: D
• Archive: No

2-
ADMINISTPLATIVE INFORMATION:
I Permit Number:
Operation Name:
Current Permitted Overatott:
Contact Person:
Company Name:
Street:
City:
State:
Area Code:
4, Successor Operator:
Contact Pet
Company Narric:
Street:
City:
State:
Area Codc:
IRS Tax ID No. or Social Security No.:
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Aye
C 0 Zip Code: go/ /0 - 136
303 Telephone: 763 - 301
PN
TIV Zip Code: _37602-
303

Application Fee: 5100.00 for Hard Rock operations; $125.00 for Construction i'vIaterials operations
Make check payable to the Division of Reclamation, Mining and Safety