2007-06-08_REVISION - M2006009 ‎(2)‎

• Permit No: M2006009
• IBM Index Class Name: REVISION
• Doc Date: 6/8/2007
• Doc Name: Submittal
• From: Mesa Sandstone, LLC
• To: DRMS
• Type & Sequence: AM1
• Media Type: D
• Archive: No

-3-
I I. Correaoondeoce Information:
APPLICANT/OPERATOR (name, address, a~ phone of name to be/~used on permit) _ 1 ~ q
Contact's Name: 11 4, ~~0~ Title: Lhi I t0.' 1"\0.vt0.c1C?/'
Company Name: M ~S Q S 5'~B ~'t t?
Street/P.O. sox: P , ~ 3 ~ ~ ~ 2~ P.O. sox:
city: ~oNf-~ ~-
State: L(~ Zip Code: ~ 13 2 I
Telephone Number: ( 9 ~ r~ 1- j ~, ~i - ~ I In 7
Fax Number: ( ) - ti ~~ - ~ l ~ ~
PERbtiTTING CONTACT (if different from applicant/operator abfove) (~ II yI p ~
Contact's Name: K n v ~' . `Tf'~A C l f~ Title: hl~C! , I ~ rm0. l 1 "\0. vtccQ e/`
Compmy Name:
Street/P.O. Box: P.O. Box:
City:
State:
Zip Code:
Telephone Number:
Fax Number:
INSPECTION CONTACT
Contact's Name:
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number: ( ~ -
Fax Number: ( 1-
CC: STATE OR FEDERAL LANDO WNFR (if anvl
Agency:
Street:
Ciiy:
State:
Telephone Number: f 1-
CC~ STATE OR FEDERAL LANDOWNER (ifany~
Agency:
Street:
City:
State:
Telephone Nmnber: ( 1-
W t << 1 ct~m ~ , ~ d~~ Title:
P.O. sox:
Zip Code:
Zip Code:
Zip Code:
o~~~~