2016-05-04_REVISION - M1986102

• Permit No: M1986102
• IBM Index Class Name: Revision
• Doc Date: 5/4/2016
• Doc Name: edited application AM01
• From: Colllins-Morehead LLC
• To: DRMS
• Type & Sequence: AM1
• Email Name: LJW
• Email Name: GRM
• Media Type: D
• Archive: No

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11. Correspondence Information:
APPLICANT/OPERATOR (name,address,and phone of name to be used on permit)
Contact's Name: Dan CollinsTitle: Manager
Company Name: CO ice../N S' l7h P.- 14-E.,4-1) U -tL
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: f )-
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: N/A
Street:
City:
State: Zip Code:
Telephone Number: ( )-