REV10235

• Permit No: M1977347
• IBM Index Class Name: Revision
• Doc Date: 3/13/1990
• Doc Name: REGULAR 112 PERMIT APPLICATION FORM
• Type & Sequence: SO1
• Media Type: D
• Archive: No

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10. Correspondance Information
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name:
Company Name
Street:
City:
State:
Area Code:
Holnam Inc., c/o Dundee Cement Co.
P.O. Box 122
Dundee
MI Zip Code: 4813].
313 Telephone:
529-2411
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name: Paul E. Thomsen
Company Name: Holnam Inc.
Street: P.O. Box 2227
City: Fort Collins
State: CO Zip Code: 80522
Area Code: 303 Telephone: [phone]
INSPECTIOJ! CONTACT (if different from applicant/operator above)
Individual's Name: Paul E. Thomsen
Company Name: Holnam Inc.
Street: P.o. Box 2227
City: Fort Collins
State: CO Zip Code: 8052:?
Area Lode: 303 Telephone: [phone]
11. Primary future _ Cropland(CR) _ Pastureland(PL) _ General Agriculture(GA)
land use _ Rangeland(RL) _ Forestry(FR) _ Wildlife Hatitat(WL)
(check one): Residential(RS) Recreation(RC) Industrial/Comnercial(IC)
Developed Water ~sources(WR) - Solid Naste Disposal(WD)
]2. Primary present _ Cropland(CR) _ Pastureland(PL) _ General Agriculture(GA)
land use _ Rangeland(RL) _ Forestry(FR) Wildlife HaCitat(WL)
(check one): Residentia](RS) Recreation(RC) - Industria]/Corrmercial(IC)
Developed Water ~sources(WR) -
To the best of my knowledge, all the information presented on this application form and
the attached Exhibits A-P are true and correct (must be signed by applicant/operator).
Date: February 1 1990 By: ~ ~_
Vice Presid t & Secretary
Ho am In .
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