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-3- <br />14. Correatwndeett Information ~~ • <br />APPLICANT/OPERATOR (came, address, and phon/e~of name to be used ou permit) <br />Contact's Name: /~lfi/'!/ /C.//70~~/~ /_ <br />P~ - Company Name: C;/!L~ (~ ~//Id~!'~~c° ~!/~,ii <br />so-eet: .S'~'2 33 /2oac/ <br />Ciry: C// ~~n -- <br />State: <br />Title: ~~CS. <br />zip code: ~Q/SZC~ - /3~'O <br />Telephone Number: ( 970 1- ~.~~ - ~Jr~D <br />Fax Number: (97d ) - ~.~~- IO.J /~ n <br />PERMITTING CONTACT (if different from a/pplicant/operator above) CT <br />Contact's Name: ~L~/7`G/" ~/drio'9 ~ Title: /" rGS , <br />n~ Company Name: <br />V Street: <br />City: <br />scares <br />Telephone Number: <br />Fax Number: <br />INSPECTION CONTACT <br />Contact's Neme: <br />Company Name: <br />StreeC <br />~i~c <br />city: C/ ',~/--p/7 <br />state: p Cr~ , / zip code: ~pi.s7 D ' /~O D <br />Telephone Number: ( / ~~ 1- 7` ~~' ~s/D <br />Fax Number: r 9rlD , - ~3~' G~ .l /D <br />CC: STATE OR FEDERAL LANDOWNER (if any] <br />Agency: /1/O~/.E <br />Street: <br />City: <br />State: <br />Telephone Number: ( ) - <br />Zip Cade: <br />CC STATE OR FEDERAL LANDOWNER (if eny) <br />Agency: <br />S[reet: <br />City: <br />State: <br />Telephone Number: ( 1 <br />Zip Code: <br />C~ zip code:.S'// ~l.~-D2 9D <br />c ~7D ~ - 26B - 5~~/ <br />( 970 , _ z68- ss.~Z <br />