2009-08-27_REVISION - M1978221 ‎(4)‎

• Permit No: M1978221
• IBM Index Class Name: Revision
• Doc Date: 8/27/2009
• Doc Name: SO application form ‎(SO-04)‎
• From: #17 Enterprises, LLC
• To: DRMS
• Type & Sequence: SO4
• Email Name: THM
• Media Type: D
• Archive: No

RECEI'VED
AUG 2 0,
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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 No.:
M-1978-221
K Bar T Pit
Lowell Klinglesmith and Lenny Klinglesmith
7576 CR 13, PO Box 1164
Meeker
CO Zip Code: 81641
970 Telephone: [phone]
Doug Dean
#17 Enterprises , " C EE
PO Box 88, 0275 CR 22
DeBeque
CO Zip Code: 81630
970 Telephone: [phone], ext. 11

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