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1 1. Correspondence Information: <br />APPLICANT'OPER4TOR (name, address, and phone of name to be used on permit) <br />Contact's Name: G C C / Y e A S Title: L:J r t <br />Company Name: �a.Cky QIiLt. rrt/ <br />Street/P.O. Box: .2 :) �' 1 y 04.1 2 s--/ P.O. Box: V 7 <br />City: 1,02 N 1 CL WL.R. <br />State: Zip Code: ' / Q. S <br />Telephone Number: ( .7 /`r ) - 7/ - 13 <br />Fax Number: ( 7 1 ¶ ) - - 35 3 S - <br />PERMITTING CONTACT (if different from applicant/operator above) <br />Contact's Name: Title: <br />Company Name: <br />Street,P.0. Box: A P.O. Box: <br />City: <br />State: Zip Code: <br />Telephone Number: ( ) - <br />Fax Number: ( ) - <br />INSPECTION CONTACT <br />Contact's Name: End LT t1'S Title: G2 Le_inE�r� <br />Company Name: / . u i// C. (;) ,t rZk/ <br />Street/P.O. Box: 2 2 C / yy p£2i/ , )c/ P.O. Box: 5f 7 S <br />City: I��5I O,l,z(_ <br />State: /16 . Zip Code: ?I.)- S.2 <br />Telephone Number: ( 7/9 ) - 3 7/ - 1/ 5 6 <br />Fax Number: ( 7/ 9 ) - 7Y � �� .3 <br />CC: STATE OR FEDERAL LANDOWNER (if any) <br />Agency: <br />Street: <br />City: <br />State: Zip Code: <br />Telephone Number: ( ) - <br />CC: STATE OR FEDERAL LANDOWNER (if any) <br />Agency: <br />Street: �� f <br />City: <br />State: Zip Code: <br />Telephone Number: ( 1- <br />