2015-10-16_REVISION - M1987103

• Permit No: M1987103
• IBM Index Class Name: REVISION
• Doc Date: 10/16/2015
• Doc Name: Application AM02
• From: E. Douglas Pit
• To: DRMS
• Type & Sequence: AM2
• Email Name: THM
• Email Name: GRM
• Email Name: WHE
• Media Type: D
• Archive: No

-2-
11. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: AA pS&P4 V�k/✓t-1 Title:��1Z�S O+G^-
Company Name: 1 �A- S I T
Street/P.O. Box: P(.s Aix /1 P.O. Box:
City: /ynn1,,'/�l,J 61iy / D
State: Zip Code:
Telephone Number:
Fax Number: (�j i� 1- 6 a- s- PERMITTING CONTACT (if different
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from applicant/operator above)
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Contact's Name: IVAA-) 6.6 f2 , Title:
Company Name: P9° �l.<4e4? ..S 0 A) 6// "•'f TA -j G1? IJJ) , / , / C
Street/P.O. Box: %/ U SD /S�k P.O. Box:
City: LIZAAn �C-(
State: CD Zip Code: _ (�
Telephone Number: ( c�-46 ) - 2 Z to
Fax Number:
INSPECTION CONTACT
Contact's Name: Title:
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number: ( ) Fax Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State:
Telephone Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State:
Telephone Number: ( ) -
P.O. Box:
Zip Code:
Zip Code:
Zip Code: