REV90554

• Permit No: M1978007
• IBM Index Class Name: Revision
• Doc Date: 4/14/1992
• Doc Name: EXHIBIT R-NOTICE OF FILING APPLICATION FOR MLR PERMIT FOR REGULAR 112 OPERATION
• Type & Sequence: CN1
• Media Type: D
• Archive: No

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9. Correspondence Information: ~
APPLICANT/OPERATOR (name, address, and phone of/~name to be used on permtt>
Individual's Name: 1,t~g22~1 ~'_ c.:,O0PE.2
Company Name: -~/~oFFA.-T (1n~~Jt~ ~oa~ I~fpafr'no1~.]t-
Street: cO./D . ~O X .!_ ~
City:
State:
Area Code:
~.ol~ Zip Code: 91G2,C.
30~ Telephone: ~Z~ - 3 Z 1 I
PERMITTING CONTACT (tf different from applicant/operator above)
Individual's Name: ?~A2~/~n~ I~~ioo2&_
Company Name: CC~..~S~Jt--'tArJI
Street: /t'~p '2q,J~,J(~/ 5T
City: C2,4i L~
State: ~Lo • Ztp Code: BI L Z~
Area Code: 303 Telephone: Q2.~-OJZS~`T
INSPECTION CONTACT
Individual's Name
Company Name:
Street:
C1ty:
State:
Area Code:

Telephone:
Ztp Code:
CC: STATE OR FEDERAL LANDOWNER (if anv)
Agency: ~~12EL1J of ~Ar--1D 1~~1AV~4E.t~^F~.7T~
Street: ~. ~ S F~1 E~Sl~~1 5'f-
C1ty:
State:
Area Code:
__(!c~~r~ Zip Code: ~IGLS~
_303 Telephone: 82~- 82Cp ~
CC: STATE OR FEDERAL LANDOWNER (tf anv>
Agency:
Street:
City:
State:
Area Code:
Telephone:
Ztp Code: