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II. ADMINISTRATIVE INFORMATION: <br />1. Permit Number: <br />2. Operation Name: <br />-2- <br />M t °ti l - v € <br />3. Current Permitted Operator: <br />Contact Person: (n� <br />Company Name: 1_. A PA t (13e-6 4" c. <br />Street: (bilO (C-L, Ma c-k (.cis* - 5f 20° <br />City: l,•3c,sk- ,t. n s.k-e. (L <br />State: <br />Area Code: <br />o6c,.z -4 rVA1 / Ste* Fats uz <br />LO Zip Code: Db7.--1 <br />3 Telephone: G. S7 L /000 <br />4. Successor Operator: 3 Contact Person: 3 e ho n , e . 6rez-l-ion <br />Company Name: I 1J 011 6'1 le 9( , <br />Street: 7 Ro 5c' ki C{ 1' 1 CJ. <br />City: J rll <br />State: (� (/0 Zip Code: <br />Area Code: <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 /> <br /> l ~/ L / <br />7 U _622) �} ��� <br />