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Get 5600 Pm 2012-2024

AND CONTROL REGISTRATION PLEASE TYPE OR PRINT 1. 2. License/File Number Authorization ID APS ID 3. Name of Applicant: Type of Organization Address and Zip Code: Phone No. ( Sole Proprietorship Corporation General Partnership Limited Partnership ) Taxpayer ID No. 4. 5. Authorization Requested (Check all that apply) Coal Noncoal Small (Up to 2,000 Tons) Large (Over 2,000 Tons) (For DEP Use Only) Limited Liability Company Limited Liability Partnership Government Agency Other Minerals.

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