PERMFILE62341

• Permit No: M1996073
• IBM Index Class Name: Permit File
• Doc Name: CONSTRUCTION MATERIALS LIMITED IMPACT OPERATION 110 RECLAMATION PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

-3-
14.
Correspondence Information:
,ICANT/OPERATOR (name,(~address, anld~phone of name to be used on permit)
Contact's Name: (<ri.w~~~ R~Uy JAS-` Title: sUpPY V i SOY
Company Name:
Street:
City:
State:
Telephone Number : ! cf '7 D 1 - '417 4 - s ~
Fax Number: ! 9 ~~ ) - -4~~ - a954
IITTING CONTACT (if different from applicant/operator above)
Individual's Name: Title:
Company Name:
Street:
City:
State:
Telephone Number:
Fax Number:
INSPECTION CONTACT
Individual's Name:
Company Name:
Street:
City:
State:
Telephone Number:
Fax Number:
Cb , Zip Code: 5 6 7 3 7
3
Zip Code:
Zip Code:
( ) -
( 1 -
CC: STATE OR FEDERAL LANDOWNER__Lif anvl
Agency:
Street:
City:
State:
Telephone Number: ( l - _
CC: STATE OR FEDERAL LANDOWNER_(if anvl
Agency:
Street:
City:
State:
Telephone Number: ( 1 -
Zip Code:
Zip Code: