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: Ab(,7zr 0 - �A-C/< J-/e Title: /r✓JgiQ
Company Name: AL-J Qzlat) o/0 Lr»Ilr1
Street: S/3/
City: C&yQ4JD S n/ . 00 D
?N) // 9�6
State: ( 9 O Zip Code: S!D Q (0
Telephone Number: ! �// 9 O S b S'
Fax Number: ( 7/ 9 O5-6-3
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: *q m eL - Title-
Company Name:
Street:
City:
State: Zip Code:
Telephone Number: ! ) -
Fax Number:
INSPECTION CONTACT
Contact's Name: S/4/VK-- Title:
Company Name:
Street:
City:
State: Zip Code:
Telephone Number:
Fax Number:
CC: STATE OR FEDERAL LANDOWNER (if any) /�
Agency: Co 11-OZ qr ll) S%2 iZE Li�G�W A1fA.6Z _
Street: /313 6AoO1nkw 5
City: 17 E.Vr�Gt2 0
State: �JGDIe/kllo Zip //code: So�37
Telephone Number: ( �0� ) - S�h ys� ( r�� /Y7f412� lJ/S
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency: /I !/A-
Street:
City:
State: Zip Code:
Telephone Number: 1 > -