PERMFILE109887

• Permit No: M1994080
• IBM Index Class Name: Permit File
• Doc Date: 7/21/1994
• Doc Name: LIMITED IMPACT OPERATION 110 2 RECLAMATION PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

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9
Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name:
Company Name:
Street:
City:
State:
Area Code:
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name: S(i1M2
Company Name: e
Street:
c; ty
State:
Area Code:
INSPECTION CONTACT
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency: .. N ~..
Individual's Name:
Company Name:
Street:
City:
State:
Area Code:
YV v
Telephone: _
Zip Code:
Telephone:
Street:
City:
State:
Area Code: Telephone:
Zip Code:
CC: STATE OR FEDERAL LANDOWNER (1f any)
Agency: /~5 ~-
Street:
City:
State:
Area Code: Telephone:
Zip Code:
5 `I rj„e4 N o G'~ 12rQ ~~- `~
~D ~ ~ G N ~ _
(.old Zip Code: gd~3~'
~, 0?~ Telephone: ~o ~o ~/ - 1rI ~ O