REV102729

• Permit No: M1977193
• IBM Index Class Name: Revision
• Doc Date: 9/3/1996
• From: AZURITE INC
• To: DMG
• Type & Sequence: AM3
• Media Type: D
• Archive: No

-3-
14. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: ~e~vare,.1.~~~.[as.Tjz, Title:~rsS~DlEnf[
Company Name: ~T~~~cn.~V'F13wQrnF~rS ~9,~n1G•
Street: 7-01 ~'T.,.aN~.` Y2a. ~'E.
city: G.~soN G-rv .
State: ~91.0(i/~.-DQ Zip Code: B~:L~.Z-
Telephone Number: ( ~(~ 1 - 2-(0°~ - ) )~ 3
Fax Number: ( ~-9 ) - 2Ao°) -~ 1140
PERNITTING CONTACT (if different from applicant/operator above)
Contact's Name:
Company Name:
Street:
City:
State:
Telephone Number:
Fax Number:
INSPECTION CONTACT
Contact's Name:
Caupany Name:
Street:
City:
State:
Telephone Number:
Fax Number:
Title: G~rl.+nr1L, l~cr.a~4s'C
Zip Code: 8122.3
r ~1~ i - °J42-41~A
r ~~~ i - °Y~r2- 418
loo n1 ii 1~..i1.-01 A.tJ Tit le:_~~NY'_ S,AQ'C.
~T~~PS1~ iitA~l~ ~Q.~ ~'O enc STS ~O . ~ =Ivy.
//~'~~~-~NOty Crr11
~9L.OR0.0O Zip Code: B~L~'2-
i ~I~ I - ?~'~- 6~4d0
s ~(~ ti - ?-~5- 81910
CC: STATE OR FEDERAL LANDOWNER (if anv) I.~/p,
Agency:
Street:
City:
State:
Zip Code:
Telephone Number: ( 1 -
CC: STATE OR FEDERAL LANDOWNER (if anvl P}(A
Agency: '1
Street:
City:
State:
Telephone Number:
Zip Code: