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o _a <br />-2- <br />II. AD~YIIIVISTRATIVE INFORMATION: <br />1. Permit Number: R~/+E~VE~ <br />AUG 2 f 2DD4 <br />2. Operation Name: <br />Division of Minerals and GeolapY <br />3. Current Permitted Operator. <br />Contact Person: <br />Compaq Name: <br />Street: <br />City: <br />State: <br />Area Code: <br />4. Successor Operator: <br />Contact Person <br />Company Name: <br />Street: <br />Ctty: <br />State: <br />Area C <br />\° <br />~a~~~ <br />~~~ <br />II2S ~x ID No. or Social Security No.: <br />- i981~~57'~ <br /> <br />iF ~. <br />~~otis <br /> <br />~~ <br />r 1.c~,~e l~~l~ <br />p ~ ~ Zip// C--odle: ~ ~ Spa <br />_( %~,_ Telephone: tlJ tO ~ - ~ ` a-~ <br />.l " 1 4 ~ ~ ~ ~a l~+ a c~ u +p <br />/~/~r! C S1J1nQ .6~~ <br />"~ 30 g 1~e'~ m e1~1 ~-~-~ ~~~ <br />~~~I~~ <br />COY C~ Zip Code: ~ o S ` <br />Telephone: ~ 3 <br />S 2 3- `~/ ~-~ S 3~ 9' <br />5. Apblieatiop Fee: $100.00 for Hard Rock operations; $125.00 far Construction Materials operations <br />check payable to the Division of Minerals and Geology <br />