2014-09-10_REVISION - M2001107

• Permit No: M2001107
• IBM Index Class Name: Revision
• Doc Date: 9/10/2014
• Doc Name: Notices SR02
• From: DRMS
• To: Various
• Type & Sequence: SR2
• Email Name: PSH
• Media Type: D
• Archive: No

-3-
11. Correspondence Information:
APPLICANT /OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: 41P Is ZA tt U— Title: ` A�'-S U CCte-
Company Name: tic+ty tee Go! oR.�a Co�nfS7FV�TatzS� 11�iG A�a4+r. bt V15tn•�
Street/P.O. Box: 2075 W r (ea P.O. Box:
City:
State: GO Zip Code: 6o6Z
Telephone Number: ( 3o 3 ) - 1357-1'754
Fax Number: ( 34>-3 ) - $57 — z93
PERMITTING CONTACT (if different from applicantloperator above)
Contact's Name:
-QAD Yt9
Title: ✓. P.
Company Name :
-47 4nq;g tom] W-
Street/P.O. Box:
14ao W AUE SveTgr iZy
P.O. Box:
City.
W iwsTM tnlSTEar-
_
State:
6:2
Zip Code:
Telephone Number:
L 303 - 0 -135
Fax Number:
( 30 3 l - 9zo — o34-:5
WSPECTION CONTACT
Contact's Name:
f2!S tt_ .d5 APP(46Ie>1�PG�afe.
Title: _
Company Name:
Strect/P.O. Box:
P.O. Box:
City:
State:
zip Code:
Telephone Number.
I )
Fax Number.
( ) -
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
—_ - -- ��
- - --
State:
_ --
�— Zip Code:
Telephone Number:
CC: STATE OR FEDERAI, LANDOWNER (if an
Agency:
Street:
City:
State: ----- Lip Code:
Telephone Number: