2005-03-08_REVISION - M1982141

• Permit No: M1982141
• IBM Index Class Name: Revision
• Doc Date: 3/8/2005
• Doc Name: Incomplete Appl
• From: Moffat Limestone Company
• To: DMG
• Type & Sequence: AM1
• Media Type: D
• Archive: No

-3-
14. Corre+oondence Wormation:
APPLICANT/OPERATOR {name, address, and phone of name to be used on permit)
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1
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ContacPsName: ~
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~nn
7
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Title: t
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7
ComparryName: n
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lr~aFFAr,G/A'I~SrDNE'l ~~.LNe.,
sireet/P.o. Box: .~/w u 4-D
1.~aD 7 i>. S, P.o. sox:3 7
City: n
,~~ ~/~ELL . L ~n .
State: ~: ~ L /912A DO Zip Code: ~~~~
Telephone Number: (~ ~/'O 1- .~ j.~ --3~,~
Fex Number. r 9'7'D ~ - 2701- 359
PERMTTTTNG CONTACT licanUoperator above)
(if different from app
Contaot's Name: nn
CSi9/Yl b= /mss H~~ I/~ Title:
Company Name:
Street/P.O. Box: P.O. Box:
Cily:
State: Zip Code:
Telephone Number: ( 1-
Fax Number: ( 1-
1NSPECTIONCONTACT
Contact's Name: oSA/YI E ~S ~ l3 o U~ Title:
Company Name:
Street/P.O. Box: P.O. Box:
City:
State: Zip Code:
Telephone Number. { 1-
Fax Number. ( 1-
Agency:
Sheet:. .
City:
State:
Telephone Number.
Agency:
Street
City:
State:
Telephone Number:
7D _
Zip Code: