REV104811

• Permit No: M1995034
• IBM Index Class Name: Revision
• Doc Date: 7/31/2001
• Doc Name: APPLICATION TO CONVERT THE BACHUS PIT M-1995-034-01 INTO A 112 PERMIT AMENDED PAGES AND COPY OF OPER
• From: DANIEL M RUSSELL
• To: DMG
• Type & Sequence: CN1
• Media Type: D
• Archive: No

U. Cnrrevuondence Inlnrmatinn:
r\PPI_ICANT/OPERATOR (name, address, and phoaa olQnama to be wed on prrmit)
Contact; Name: ~i9n// FG /~• /\ NSSr~LL Title: O/~E~ATO~
Company Nama:
Street: ~o4Z so. /o(a ~d
C iri~: ~} L i4/Y/ O S~
State: ~LO ~AbO Zip Code ~ //O /
Telephoue Number: (7t 9 ) - $e ~/ - .3 00 ¢ ~ X f //D
Fa~Number: -71 /9 )- 58~}- 37/z
PERMITTING CONTACT (if different Gom applicant/operatorsbove)
Contact's Name: ~A/Y/r Tide:
Company Name
Street:
City:
State: Zip Code:
Telephone Number: ~~ -

Far Number: ~~ -

INSPECTION CONTACT
Contact's Name: ~7IF/19C Title:
Company Name:

Street:

City:

State: Zip Code:
Telephone Number
Far Number:
CC: STATE OR FEDERAL LANDOWNER (if wv)
Agency: /1/O.J C
Street:
City:
State:
Telephone Number: ~~ -
Zip Cade:
CC: STATE OR FEDERAL LANDOWNER (if and
Agency: /I/0~/L'
Street:
Cin':
Slate:
Zip Code:
Telephone Number: I___~ -