2007-10-26_REVISION - M1980110

• Permit No: M1980110
• IBM Index Class Name: Revision
• Doc Date: 10/26/2007
• Doc Name: Amend Appl- Updated Info.
• From: Civil Resources
• To: DRMS
• Type & Sequence: AM5
• Media Type: D
• Archive: No

-3-
1 t. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: tom
_
_
Company Name: I
,, I
~ X70 ~[~~/iC ~I-t~ ~}~
Street/P.O. Box: o~~ x'719 F. !ate 1'~O/,~/~at ~
ary: ~il KDr~.
Sta[c: ~~
Telephone Number: (3 D 3 ~ - _~3? _ 3 Se~
Fax Number: ~ .30 3 ~ - ~,3 ~- 3 Spa
PERMITTING CONTACT (if
diff
erent from applicant/operator above)
Contact's Name: ~
~
I /?I~I7Li, ~!-~i 7_
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number:
Fax Number:
INSPECTION CONTACT
Contact's Name:
Company Name:
StreeUP.O. Box:
~~
Title: /l t4NQ~Z c~ ~#! ~/
Zip Code: ~d0 ~~
Title: !I ~CI~d~P/Z
P.O. Box: !0 YFiO
Zip Code: 1$~U ~.~~)
'T'itle: ;~lQ~/~C/Z-
P.O. Box: (~a't~
fCB/ K;rv
city: YIL
~
State: _~_ Zip Code:
/
Telephone Number: ,3( ~ ~ ) - B
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~
'J ~ I ~I
~D ~i1Lr o20 3
p
G
r
7
Fax Number: (.~0'~ - t~ ') ~ - r~0
CC: STATE OR FEDERAL LANDOWNER (if any]
Agency: _. _
Street;
City: __
State: Zip Code: _
Telephone Number: ~ 1-
CC: STATE OR FEDERAL LANDOWNER if an )
Agency: __,_
Street:
City: - -- --
State: Zip Code:
Telephone Number: ( ) - _ _
3 C7 _ k'33 ~ / / ~2 0 3
{ 3a3 , _ 83.3 - ~S