PERMFILE50207

• Permit No: M2004030
• IBM Index Class Name: Permit File
• Doc Date: 4/23/2004
• Doc Name: 110c Appl
• From: T Bone Stone Inc.
• To: DMG
• Media Type: D
• Archive: No

14.
.3.
Correspondence Iaformatroa:
APPLICANT/OPERATOR
Contacts Name:
Company Name:
r
Street/P.O. Box: ~
City: ~
State: _
address, and phone oyf~name to be used on Permit)
~ ~, 1~ Title: 7/lEs ~M
Telephone Nmmber: c3 y~ ) -
FaxNmmber: (~03 }
PERMITTIIIG CONTACT (if different from applioant/operator shave)
Contacts Name:
Compaq Name:
Street/P.O. Box:
City:
State:
Telephone Number: ( ) -
Fax Nmmber. j ) -
Contacts Name:
Company Name:
Street/P.O. Box:
City:
state:
zip code: SrD ~ o I
Telephone Number: (`i03 )-"~J~+~4'~Sb a"~
Feu Nmmber: ~ ~1- 77~ - ~~ 39
CC: STATE ORFIDERAL LANDOWNER (if ~
Agency: W ~ N ~--
Street:
City:
state: zip Cede:
Telephone Number: [ ) -
CC: STATE OR FIDERAL LANDOWNER (tFanvl
agency: lU 0 N 2.
Stpxt:
city:
state:
Telephone Nmmber: ( ) -
P.O. Box:
~ ~:
zip Code: