REV15471

• Permit No: M1980014
• IBM Index Class Name: Revision
• Doc Date: 1/10/1996
• Doc Name: REGULAR OPERATION 112 RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: CN1
• Media Type: D
• Archive: No

-2-
10. Correspondence Information:
APPLICANT/OPERATOR (name, ad~dress, and phone of name to be used on permit)
Individual's Name: /IoNRad ~ OK~? SR,~}ssisT iPei-,o rt/3Ri06E CoORO
Company Name: p4Rff ~6G/VTY ~eAO t.QQ/oFE
Street: fib. /~i4
City: FA/R P~CAY Lo 9, o S/NO
State: l OL o RAn/~ Zip Code:
Area Code: rl /S Telephone: B,'~,L-2 7 7 / EXT .28'3
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name: ,~AfV( Lc AS ~PQOVL~
Company Name:
Street:
City:
State:
Area Code:
Individual's Name:
Co~any Name
Street:
City:
State:
Area Code:
Telephone:
Zip Code:
SarnE Ar Aaaye
Telephone:
CC: STATE OR FEDERAL LANDOWNER (if an
Zip Code:
Agency:
Street:
City:
State: Zip Code:
Area Code: Telephone:
CC: STATE OR FEDERAL LANDOWNER fif anv)
Agency:
Street:
City:
State:
Area Code:
Telephone:
Zip Code: