2007-03-10_REVISION - M2004078

• Permit No: M2004078
• IBM Index Class Name: REVISION
• Doc Date: 3/10/2007
• Doc Name: SO APPLICATION
• From: CITY & COUNTY OF DENVER
• To: DRMS
• Type & Sequence: SO1
• Email Name: ECS
• 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.:
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• GP Zip Code: 2- 2 /
3 e, Telephone: �! 0 O°
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5. Application Fee: $115.00 for Hard Rock operations; $144.00 for Construction Materials operations
Make check payable to the Division of Reclamation, Mining and Safety
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