2004-09-29_REVISION - M1999120

• Permit No: M1999120
• IBM Index Class Name: Revision
• Doc Date: 9/29/2004
• Doc Name: 112‎(c)‎ Amendment Appl.
• From: L.G. Everist Inc
• To: DMG
• Type & Sequence: AM1
• Media Type: D
• Archive: No

3-
14. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: ~. A• ~U~QIcS"~ ~ Title: ~Q-~ I~~7
Company Name: ~~. FI~ EL`En Ic57~ /IJ ~-.
StreeUP.O. Box: 7.~ 2 I F. Bg~ Aug ~ U, ~E ~-O p,0. Box:
City: ~
~1~~1.°.~~~
State: //~~
CN LO Q.J1-A~O Zip Code: t~ ~a ~~
Telephone Number: p
U 3 _ 2 O
~- ~~OCS
~P
Fax Number: p.(
p
r .~3 ~ - Z~ / - ~ c3 y0
PERMITTING CONTACT (if diff
e
r
ent from applicant/operator above)
Contact's Name: l
~
n
PA-u~ ~ESuG Title: P2 /N~1/~At-
Company Name: ~ ~ ~G ~ (/ C
_ _ ~~ ~
S[reet/P.O. Box: II//
~~ rl.I P LI/lJ(~ S~T c~U I 1 E j ~ 7 P.O. Box:
City: ~ lLE ~i3`r$-~ J
L
Stale: n
(~ I--O~~G Zip Code: ~Z~c~

Telephone Number. 'a 2`Zy-yz77
3 ~ -
c
~

Fax Number: -~
~ TT
p,
( d"v~ 1- Z~N_cpC~~2 /
INSPECTION CONTACT

Contact's Name: I /
N MQ~
~S~
Title: ~~
U~-~TaR ~ MFJ~-.
Company Name: /
n
C~
L ~ ~ . E ~
-~c~ T
/
NC-
StreeUP.O. Box: A- ~-
-
p
~
721 E OOH /-~ V c ~ U I TF ~~ P.O. Box:
City: b~
State: ~a ~~
D Zip Code: ~ ~D d
Telephone Number: ,, , /q
~j
c _ 3 ~ ~ - Zp ~ 7iUY /
Fax Number: r .3 0~ ~ - 2g9~ ~3 ~/R
CC: STATE OR FEDERAL LANDOWNER (if anv)
Agency:
Street:
City:
State: Zip Code:
Telephone Number. ( ) -
CC' STATE OR FEDERAL LANDOWNER (if anvl
Agency:
Street:
City:
State: Zip Code:
Telephone Number. ( ) -