2019-08-15_PERMIT FILE - M2019038

• Permit No: M2019038
• IBM Index Class Name: PERMIT FILE
• Doc Date: 8/15/2019
• Doc Name: 110‎(1)‎ Permit Application
• From: CBRG
• To: DRMS
• Email Name: ERR
• Media Type: D
• Archive: No

-2-
9. Correspondence Information:
APPLICANT/OPERATOR(name,address,and phone of name to be used on permit):
Contact's Name: Ez ,J Title: n 6 R 6
Company Name:
Street: P.O.Box:
City:
State: -o I & Zip Code: �n q U
Telephone Number: ( `j'Q ) - 52
Fax Number: ( g et 1"4) -
PERMITTING CONTACT(if different from applicant/operator above):
Contact's Name: �z c� 1 _1 Title:
Company Name:
Street: P.O.Box:
City:
State: Zip Code:
Telephone Number: ( )Fax Number: ( ) -
INSPECTION CONTACT:
Contact's Name: Title:
Company Name:
Street: P.O.Box:
City:
State: Zip Code:
Telephone Number: ( )Fax Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER(if any): C
Agency: r"-eA Ca—
Street: f3 ns
City:
State: C / v Zip Code:
Telephone Number:
CC: STATE OR FEDERAL LAN OWNER(if any):
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( ) -