2016-12-16_REVISION - M2011017

• Permit No: M2011017
• IBM Index Class Name: REVISION
• Doc Date: 12/16/2016
• Doc Name: Response to FW Reduction Request Consideration
• From: DNR Water Resources
• To: DRMS
• Type & Sequence: SR1
• Email Name: ACY
• Media Type: D
• Archive: No

cCENED
;i IE :R -2-
11. Correspondence Information:
APPLICANT/OPERATOR (name,address,and phone of name to be used on permit)
Contact's Name: Rick Domson Title: Sec/Treas
Company Name: Breeze Basin Resources
Street/P.O. Box: P.O. Box: 181
City: Hayden
State: c0 Zip Code: 81639
Telephone Number: ( 9 7 0 _ 3 2 6—8 6 8 9
Fax Number: 979 824-2840
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: Title:
Company Name:
Street/P.O. Box: P.O. Box:
City:
State: Zip Code:
Telephone Number: ( )Fax Number:
INSPECTION CONTACT
Contact's Name: Rick Domson Title: Sec/Treas .
Company Name: Breeze Basin Resources
Street/P.O.Box: P.O. Box: 181
City: Hayden
State: c0 Zip Code: 81639
Telephone Number: ( 9 7 0 _ 3 2 6—8 6 8 9
Fax Number- ( 970 824-2840
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: ( )-