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II. ADMINISTRATIVE INFORMATION: <br />1. Permit Number: <br />2. Operation Name: <br />-2- <br />M 11 7 q- o62- <br />No m+4.4 o€-- 1 t" <br />3. Current Permitted Operator: 7� <br />Contact Person: �o4G 1t -1 1 A `3 <br />Company Name: L_4,04•4e. Lc�Gs -�- rise, <br />Street: lei " To G•Lv►e,e• Rj &) (,�q y 56,;4-4. 2OZ' <br />City: l43c.t+/ta ;mot s-}eR <br />State: 6.0 Zip Code: VbC z. 1 <br />Area Code: a ! Telephone: 6S 1 NODS' <br />4. Successor Operator: <br />Contact Person: O ,Y �o � ,4� � �/� smiler <br />4:)\ Company Name: �` , ...De 144_, <br />C � t <br />Street: 31.E Ynt2 ; rt) <br />City: 14 (7- <br />State: - Zip Code: R l 4 .11 /e <br />Area Code: 970 Telephone: g74 - ?S'l <br />IRS Tax ID No. or Social Security No.: <br />5. Application Fee: $115.00 for Hard Rock operations; $144.00 for Construction Materials operations <br />Make check payable to the Division of Reclamation, Mining and Safety <br />