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02/11/2002 18:94 FAE 719 852 5J58 <br />I <br />14. Co~poodence Inforp[atlao: <br />C R.^.G <br />APPLICANT/OPERATOR (name, address, and phone of name to 6e used on permit) <br />ContacisName: M 22tr_t_ iJRIGNT Title: ~0.ESIDEIV7 <br />Company Name: 1 ie c a '-Ar ~r ~ ~ ~ 6 t2aJE'~~ SiJ G <br />saeee aa~~a Nt~ LaY 2Ss (Mat~.l~ ALDrt~s51 PD Box 15~ <br />City. ~EFFF~561.~ <br />Staze: GQ zip Cock: SL)45~r, <br />Telephone Number: 0714 ] - 8 -- 2 C9~ <br /> <br />PERMUTING CONTACT (if di8:e[en[ hom applitanUapera[or above) <br />Individual'sNamc: SHAQI.FS SP1E~.MAa..I Title: <br />Company Name: <br />Staee[ <br />City. <br />i State: <br />Telephone Number: <br />FaxNumbc: <br />INSPECTION CONTACT <br />Individual's Name <br />CotnpaayN[une: <br />SueeC <br />City. <br />Sta[c: <br />Telephone N[unbet: <br />'771 SPt?u[~ERD <br />f_ IN,Aa v DwJ <br />1) Zip Code: $ l 2,Z O <br />r 47c ) - szr 2- f?2b4 - <br />~{A2LLS ~ pIEL~-tom Title: <br />'771 Gva,>~c Q~ <br />C lwrA¢aowl <br />C zip Code: S 122.E <br />L~ 1- gb2-S2-~4- - <br />Fax Number: ~_____]~ - <br />Agcocy. <br />Saeec <br />C{ty. <br />Stare: <br />Tdcphooe Numbs. <br />Zip Code <br />CC: STATE ORSTATE OR PEDII2AL~OWNFR Iif anv)fif env) <br />A6~sY• <br />Seeet: <br />City <br />Stale: <br />VYORDS PLUS ~OJ <br />~FCFIVFn BY FAX <br />3 _ SEP 1'- R~C'D <br />Zip Code: <br />Telephone Numhcr: ( - <br />