2016-01-22_REVISION - M1986102

• Permit No: M1986102
• IBM Index Class Name: REVISION
• Doc Date: 1/22/2016
• Doc Name: Application AM01
• From: Dan Collins / Collins-More-head, LLC
• To: DRMS
• Type & Sequence: AM1
• Email Name: LJW
• Email Name: GRM
• Media Type: D
• Archive: No

-2-
11. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on pennit)
Contact's Name: Dan Collins
Title: Manager
Company Name:
Street/P.O. Box: 1417 S. Grandview Dr. P.O. Box:
City: Tempe
State: Arizona Zip Code: 85281
Telephone Number: ( 480 ) - 206-2037
Fax Number: ( ) -
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: Same Title:
Company Name:
Street/P.O. Box• P.O. Box:
City:
State: Zip Code:
Telephone Number. ( ) -
Fax Number: ( ) -
INSPECTION CONTACT
Contact's Name: Same Title:
Company Name:
Street/P.O. Box: P.O. Box:
City:
State: Zip Code:
Telephone Number: ( ) -
Fax Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency: N/A
Street:
City:
State: Zip Code:
Telephone Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
N/A
State: Zip Code:
Telephone Number: ( ) -