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- 3 - <br />14. Correspondence Information: <br />APPLICANT/OPERATOR (name, address, and phone of name to be used on permit) <br />ContacisName: IDE'Tr= 51rr6~~t/O Title: VICE PRES14~t' <br />Company Name: OLAC~ISTLE S(t) ~df . ~ll,~'r ~4 U!/lTEl1 C~/1(/Q4A1lE.S Q~~i1~Cf~N7y <br />Street-. aa73 . RUI~'R 12bA~A An I.LnR ~36flcf <br />city: Io~QA~d ~"uNcrto%1 <br />State: l_FJ40QALl~ Zip Code: ~~Jr~ <br />Telephone Number: ( Q~) - ~'~ ' ~ qOD <br />Fax Number: 7~ - a~3 ~Q <br />PERMITTING CONTACT (if different from applicandoperator above) <br />Individual's Name: ~~E6 ~Lt)1CbC1 Title: APtNCIP/!~ <br />Company Name: ~ E(o /~ilM/,mil/ 9~ ~cSSOe!/~TE$ <br />Street: //~i~/ UTA~P~P[A1~TDA) ~At~l~!- <br />cny PARx~P <br />State: ~ Zip Code: ~S ©IS S <br />Telephone Number: (3©3) - 3~}6 cs~9'bt <br />Fax Number: (~3 1 - ~yrri 697 <br />INSPECTION CONTACT /~ <br />Individual's Name: ~7~ v~6Ero/fLU/V+0 Title: 11te~ `~ldl=tl~r <br />Company Name: OL~ej1$Y,ty~ cSGt) ~C !/fit ~Ak' . d~ (91U17'EO 't1YYlPf~rUl~ ~QGi1QF~ C(•tlAl7Y <br />Street: „~,Z73 IQ(,JE72 ROAd ~ tg©JC ~iDq <br />City. tnildfMJd 1TU~C'-71Qt1 <br />State: <br />Telephone Number: 7~ - .~If 8 ~~~ <br />Fax Number: { ~ Z~) - a~~<3 ~Q~cS <br />CC: STATE OR FEDERAL LANDOWNER (if anv) <br />Agency <br />Street: <br />City. <br />State: <br />Tetephone Number: ( 1 - <br />CC• STATE OR FEDERALLANDOWNER_{ifan~ <br />Agency. <br />Street <br />City. <br />Stale: <br />Zip Code: ~ /~© a <br />Zip Code: <br />Zip Code: <br />Telephone Number: { ) - <br />