2012-10-11_REVISION - M2010012

• Permit No: M2010012
• IBM Index Class Name: REVISION
• Doc Date: 10/11/2012
• Doc Name: INADEQUATE SO APPLICATION
• From: DRMS
• To: MULLET EXCAVATING
• 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 Name:
Street:
City:
State:
Area Code:
IRS Tax ID No. or Social Security No.:
-2-
Make check payable to the Division of Reclamation, Mining and Safety
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Zip Code: S (25 2—
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0 Zip Code: 5/2/5
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5. Application Fee: $115.00 for Hard Rock operations; $144.00 for Construction Materials operations