REV98980

• Permit No: M1995034
• IBM Index Class Name: Revision
• Doc Date: 9/5/2000
• Doc Name: CONSTRUCTION MATERIALS LIMITED IMPACT 110 OPERATION RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: AM1
• Media Type: D
• Archive: No

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ld. Cnrrevoondence Information:
.~PLICANT/OPERATOR (namc, address, and phone of name to be used on permit)
Contact's Name: J~fI N l EL /J7 • fPu SSELC Title: OW NN/L
Compan}'Name: l' ~~
Sheet: °!0 4Z $U ~ l4 (o~ d
cih~: R L Ai/Io~.9
State: ~'l~ Zip Code: F3 //U /
Telephone Number: { ~ ~ q 1- 589- 3 00 ¢ Ex f //O
Far' Number: 7( 1 9 1- S 8r/- 3 7 J Z
PERMITTING CONTACT (if different from applicanUoperatorebove)
Contacts Name: 5 /? /YJc~
Company Name:
Street.
City:
State:
Telephone Number: ~1-
Fax Ntrmber S~ -
INSPECTION CONTACT
Zip Code:
Contact's Name: 17f1 N /FL //'/ • ~C u S S F~ L Title: O (.J n/ t
Company Name: ~ ' ~ '
Street: g O ¢ z SO . ~O /o ~~•
city: A GA rr/oSA
State: ~ Zip Code: .g // O /
Telephone Number: (71 °J 1- SBoI- ~Oc~'~ LAX f J J O
Fes Number: (719 1- .5~ - 3'7 I Z.
CC: STATE OR FEDERAL LANDOWNER f if and
Agency: /1~ ~l~
Street.
City:
Slate:
Telephone Number: L-~ -
Zip Code:
CC: STATE OR FEDERAL LANDOWNER (if anvt
Agency: ~ ~
Street:
City:
State:
Telephone Number:
Zip Code: