PERMFILE126033

• Permit No: M1994080
• IBM Index Class Name: Permit File
• 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:
ct ty:
State:
Area Code:
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name: S~ 1M 2
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
INSPECTION CONTACT
Individual's Name: S Ci 1'x'1 P
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
CC: STATE OR FEDERAL LANDOWNER (1f anv)
Agency: N~...
Street:
City:
State: Zip Code:
Area Code: Telephone:
CC: STATE OR FEDERAL LANDOWNER (if anv>
Agency: n5
Street:
City:
State: Zip Code:
Area Code: Telephone:
~DUP-IG N r1
~.017~ Zip Code: 8'd538
"~, 0?~ Telephone: to ~o ~/ - 1 ct ~ ~