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-2- <br />6. Corres~ondenee Infornmtbn: <br />APPLICANT/OPERATOR (name. address, and <br />p~~a of name to 6e used on permit) <br /> <br />ContacCsNsme: l <br />_~1'tGk~ In~.b~Y' Tick: Dw/neY' <br />Conyaay Name: 5?Nt d ii <br />(a ~' ~( 1 <br />StteeuP.O. Boz I• <br />(~ E. Ll.$. 1 VIYII 16~ P.O. Box: <br />city: 'aa S /'~ s <br />State: Go o t.,zd0 zip code: 51 14-7 <br />Tekphoa Number: { ~7 ~ ~ _ 2 (od- - <br />~j~o $ <br />Fax Number. q <br />( 9~O 1- 2(7t~- J0~7g <br />PERMITTING CONTACT (if dill from applit~ffilapetatar above) <br />ContacfsNaor: tin2rr• " 11" Ca/"/1a~~Yl Tiile: ~' J~I~ <br />Cortmarty Name: <br />Street/P.O. Box: ~•O. ~X 19 5 ~ P.O. Box: <br /> <br />City. Ra.l i~c~ <br />smre: ~I ado zip Code: 81122 <br />Tekphaa Number: ( 970 1 _ 7Sg <br />Fax Number. ( ~j70 ) _ Q~ ~ 50 :172 <br />INSPEC110N CONTACT <br /> I <br />// - n ~ <br />~ <br />~ ~ <br />~ <br />12 <br />~ ~ S c G 2ho./t, <br />C2rh T <br />~ <br />ContacCs Name: Fi-/1 <br />~/ <br />/ <br />S N/ i <br />Ue <br />Company Name: <br />StreeUP.O. Box: <br />City. <br />State: <br />Tekphoa Numbs: ( 1- <br />FazNumber: { ~ _ _ <br />CC: STATE OR FEDERAL LANDOWNER (ifaml <br />Ageac: <br />Street <br />City: <br />Stau: <br />Tekpboa Number: ( 1- <br />CC: STATE OR FEDERAL LANDOWNER (if amt <br />Agency. <br />Street <br />City: <br />State: <br />Tekphoa Number. ( ~ <br />P.O. Box: <br />Cade: <br />Zip Code: <br />"Lip Code: <br />