2016-10-13_REVISION - M2005070

• Permit No: M2005070
• IBM Index Class Name: Revision
• Doc Date: 10/13/2016
• Doc Name: Application
• From: Krehmeyer Pit
• To: DRMS
• Type & Sequence: CN2
• Email Name: WHE
• Email Name: ERR
• Media Type: D
• Archive: No

-3-
11. Correspondence Information:
APPLICANT/OPERATOR (name,address,and phone of name to be used on permit) J
Contact's Name: ✓ Title:
Company Name: / >
Street/P.O.Box: ✓�fJ9 /d��`��t /� SJI. P.O.Box:
City: �/2?
State: �� Zip Code: 9a
Telephone Number:_)- S�B
Fax Number: ?,0 A/,( 6
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: RQ_I-)//I �!� Title:
Company Name:
Street/P.O.Box: 3 (�p�(L Z l P.O.Box:
City: r�
State: Zip Code: Xe 7,3_
Telephone Number: ( 97,0 )- - 7 7 — 26 •-
Fax Number:
7(�
INSPECTION CONTACT / /
Contact's Name: J,e rry �a TC-1 e�z Title:
Company Name:
Street/P.O.Box: 4 4 444 4 0V P.O.Box:
City:
State: Sd/,r,7 ees ✓e Zip Code:
Telephone Number: ( )Fax Number: ( )-
CC: STATE OR FEDERAL LANDOWNER(if any)
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( )-
CC: STATE OR FEDERAL LANDOWNER(if any
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( )-