REV14039

• Permit No: M1983159
• IBM Index Class Name: Revision
• Doc Date: 4/12/2001
• Doc Name: CONSTRUCTION MATERIALS REG 112 OPERATION RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: CN1
• Media Type: D
• Archive: No

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14. Correspondence information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: ~ ~ `Tn rn V Fg/R~ rvt n IC /~ T Title: ~,~ rtC+,
Company Name: rA2rh t rS (~~+nS ~ UJ ~ ~ L n ~.
Sneer. 3?Hlg Cn~y Rd 37.dD Nlt/Y /HS
city: lei Ir
State: ~, p, ~n ~ u ,~ D Zip Code: ~/y.~
Telephone Number: ~~ - 3 `et 7 - y3/~
Fax Number: r 9 ~ r~~ - 3.? 7 - 6 3~l D
PEBMITTiNG CONTACT (if difl'erent from applicanUoperator above)
Contact's Name: Gt
Company Name:
Sveet:
city:
State:
Telephone Number:
Fa>; Number:
INSPECTION CONTACT
Conuct's Name:
Company Name:
Street:
City:
State:
Telephone Number:
Fax Number:
Agency:
Street:
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Title:
zip code:
S><eve Hend'ta~son Title: (,a - Ow n r 2
/'A /r1EK.4 ~nnS ~. Cu. cLrr G,
Zip Code: ~~q~~
f R~o~- X17-y.~/G
c 97v~- ?~7-~3Sd
Citv:
State:
Telephone Number: L--) -
Zip Cade:
tiC: STATE OR FEDERAL LANDO' VNER (if anv)
Agency:
Street:
City:
State:
Cade:
Telephone Number: ~_) -