1997-02-12_REVISION - M1985043

• Permit No: M1985043
• IBM Index Class Name: Revision
• Doc Date: 2/12/1997
• Doc Name: CONSTRUCTION MATERIALS REGULAR OPERATION 112 RECLAMATION PERMIT APPLICATION FORM
• 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: ZO 6 72- 0— S�A-Cl-- J2 Title:
Company Name:
Street: glUllc-%/
City: c`n CP2/1�k S XlLi a�
State: Zip Code:
Telephone Number: ( 7/ % 1
Fax Number: ( 7/ 9 )
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: Title:
Company Name:
Street:
City:
State: Zip Code:
Telephone Number: 1 1 Fax Number: 1 1 -
INSPECTION CONTACT
Contact's Name: Title:
Company Name:
Street:
City:
State: Zip Code:
Telephone Number: ( 1 -
Fax Number: ( 1 -
CC: STATE OR FEDERAL LANDOWNER (if any) /
Agency: Co 1 fo PAr/n 5%� i� Li¢Js/c �FJC�
Street: /3 /O 5�&72mA ✓ S 7-
City:
G NUcr2
State: Zip Code: 50Zf93
Telephone Number:
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( 1 -