2000-03-13_REVISION - M1994053

• Permit No: M1994053
• IBM Index Class Name: Revision
• Doc Date: 3/13/2000
• Doc Name: RECEIPT
• From: DMG
• To: BASE PRODUCTS
• Type & Sequence: AM1
• Media Type: D
• Archive: No

14. Correspondence Information:
APPLICANT/OPERATOR (name.address.and phone of name to be used on permit)
Contact's Name! Title:
Company Name:
Street:
City:
State: Zip Code:
Telephone Number: (Fax Number: ( 1-
PERMITTING CONTACT (if different from appGcant/operator above)
Contact's Name: Title:
Company Name:
Street:
City:
State: Zip Code:
Telephone Number. (Fax Number:
INSPECTION CONTACT
Contacfs Name: Title:
Company Name:
Street:
City:
State: Zip Code:
Telephone Number. ( )Fax Number: ( )
CC: STATEOR FE12ERAI,LANDOWNER(if y)
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( 1-
CC: STATE OR FEDERAL LANDOWNER(if anv)
Agency:
Street:
Cirv:
State: Zip Code:
Telephone Number: { 1-