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II. ADMINISTRATIVE INFORMATION: <br />1. Permit Number: <br />2. Operation Name: <br />-2- <br />M- (4210 - `/ <br />Make check payable to the Division of Reclamation, Mining and Safety <br />Br a.►1cl s + cL c U 7v plc. Pi )- <br />3. Current Permitted Operator: <br />Contact Person: 14 ax 01 cl 73 r a.n.cf S +&cL "L <br />Company Name: /..i A <br />Street: .Q a U y iit, c,( <br />G R <br />T <br />City: tD'2 -14 4 // <br />State: l_-t...0 - Zip Code: % i 4 1 IP <br />Area Code: 9 7 0 Telephone: $ 7 4- L 1 S <br />4. Successor Operator: 6-0-r 1 I <br />Contact Person: L. 444 r 0. 01 ST Cl CI 4 <br />Company Name: /. A <br />Street: o. O t o2 i Rot_ <br />oL <br />City: 1 / ` '}' C.k_ ' / <br />State: CO p t Zip Code: O 1 '1 1 IP <br />Area Code: 9 70 Telephone: .:2 / - y 5 <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 />