2011-12-16_REVISION - M2010036

• Permit No: M2010036
• IBM Index Class Name: REVISION
• Doc Date: 12/16/2011
• Doc Name: SO Application
• From: Crystal Springs Ranch, Inc.
• To: DRMS
• Type & Sequence: SO1
• Email Name: BMK
• Email Name: TAK
• Media Type: D
• Archive: No

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 Nanie
Street
City:
State
5 Application Fee:
-2-
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7;; H Qhsel
&c'a7 Alc/r Dr,
S4i, 4Q /QnSQ
ah' Zip Code: 99S f
O
7o7 Telephone: 7 g 3 '119
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, 7c3 I kc.4. 4 e �1(
t( E6f'St)
Zip Code: i J5'
Area Code: Telephone: 7 / G( 3
IRS Tax ID No. or Social Security No : 7/5' M j Y(7,2 3 //0/'17e*""
$115.00 for Hard Rock operations; $144.00 for Construction Materials operations
Make check payable to the Division of Reclamation, Mining and Safety
DEC 1 2011
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