2002-03-04_REVISION - M1996076

• Permit No: M1996076
• IBM Index Class Name: Revision
• Doc Date: 3/4/2002
• Doc Name: Conversion Application
• From: Rudolph Fontanari
• To: DMG
• 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 peraut)
Contact's Name: ~ /Cdr.~Ii ~/7~zJ'/~Q/'/ ~ Title:~a~~~'~c°TV/
Company Name: C~4/n~0 ~.QAI~t~L-
street: 33/~ ~-a/,r woad ~ .
city: C/i~~`o,~
State: ~ Zip Code: t~/~2 0
Telephone Number: r 970 ~ 7'34- 7Y*~8
Fax Number: ~~ -
PERMITTING CONTACT (if di$erent from applicanUoperator above)
Contact's Name: Sl.~l~ Title:
Company Name:
Street
City:
State:r Zip Code:
Telephone Number: i_~ -
Fax Number: L-~ -
INSPECTION CONTACT
Contact's Name: 5~~11 ~ Title:
Company Name:
Street:
City:
State: Zip Code:
Telephone Number: (_~ -
Fax Number: ( 1-
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency: d/m ~ P
Street:
City;
State: Zip Code:
Telephone Number: j_~ -
CC: STATE OR FEDERAL LANDOWNER (if anvl
Agency: /~Qe
Street;
City:
State: - Zip Code:
Telephone Number: ~~ -