PERMFILE57860

• Permit No: M1995057
• IBM Index Class Name: Permit File
• Doc Date: 8/22/1995
• Doc Name: LIMITED IMPACT OPERATION 110 2 RECLAMATION PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

10. Correspondence Information:
APPLICANT/OPERATOR (name,
Contact's Name:
Company Name: _
Street:
city: ~2L/~~ CAcO~H40 O
State: GOLfl~eFaao Zip Code: Si23
Telephone Number: ~-L - ~O7 / - ~~~lo
Fax Number: ( ) -
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
State:
Telephone Number:
Fax Number:
INSPECTION CONTACT
Individual's Name
Company Name
Street:
city:
State:
Telephone Number:
Fax Number:
-a-

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~G/Qy 2G/o/Bi9G/GT~ ~) Title: Qi!/~Fjl.
j 2 9 ~ CON//T y reg94 /YDi 7C0
Title:
Zip Code:
i ) -
( ) _
(,f/f)~,e ~ //i Gl/iL GO.r
Gu,~/~Ji sa,r/ G,eA//EL
~~~ol WESr N/6HW.4Y ~ So- /.°o, /~arfl2
G urlr/~ sor/
GoLO,r~'i Q~ Zip Code: ~//Z 3~
(l/70 ) - ~o`//- Sg// f -,3088 EdE.dsYss
~o _ ~y/- Sg / /
Agency: ~/ n
Street:
City:
State: Zip Code:
Telephone Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER (if anv)
Agency: y~/1
Street:
City:
State:
Zip Code:
Telephone Number: