2015-04-16_REVISION - M1989009

• Permit No: M1989009
• IBM Index Class Name: REVISION
• Doc Date: 4/16/2015
• Doc Name: Notice
• From: DRMS
• To: Various
• Type & Sequence: AR1
• Email Name: AME
• Media Type: D
• Archive: No

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10. Correspondance Information
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name: hUdy Ynr:oags Jim Greenfield, jr-
Company Name: 3 -1jIge Inc.
Street: P- n. Bn- 1 Kna
Ci ty : Lamar
State: +Ca1 e3=de - Zip Code: 81052
Area Code: 13_9 _ Telephone: 336361 or 336 -2302
PERMITTING CONTACT (if different from applicant /operator above)
Individual's Name:
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
INSPECTION CONTACT (if different from applicant /operator above)
Individual's Name:
Company Name:
Street:
C-Ity:
State: Zip Code:
Area Code: Telephone:
11, Primary future ❑ Cropland(CR) ❑ Pastureland(PL) ❑ General Agriculture(GA)
land use ❑ Rangeland(RL) ❑ Forestry(FR) ❑ Wildlife Habitat(WL)
(check one): ❑ Residential(RS)❑ Recreation(RC) ® Industrial /Commercfal(IC)
❑ Developed dater Resources(WR) ❑ Solid Waste Disposal(WD)
12. Primary present ❑ Cropland(CR) ❑ Pastureland(PL) ❑ General Agriculture(GA)
land ise (3 Rangeland(RL) ❑ Forestry(FR) C3 Wildlife Habitat(WL)
(check one): ❑ Residential(RS) ❑ Recreation(RC) ❑ Industrial /Commercial(IC)
❑ Developed Water Resources(WR)
To the best of my knowledge, all the information presented on this application form and
the attached Exhibits A -G are true and correct (must be signed by app can operator),
I s
Date, =1��ja 6y:
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