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z- <br />6. Correspondence Information: <br />~~~APPLICANT/OPERATOR (name, address. and phone of vanm to be used on permit) <br />Contact'slvamc: Jin1 UetI~6C ~C~>~1 S+e'^laf~" /`~ ;/~ <br />ContpanyName: IVl c`~a. f"kon D: ~ CeM AN ~ I' I <br />StreeuP.O.Box: X43 Ncr;x.EO C}. Sts 2~0 ~/0 ~ t, Stn <br />C7 <br />-7 <br />,~ <br />G 1N5YF,C:T1ON CON1'AC'f nn n 1 1 <br />f~ Contact's Name: I~~II ti^~ ''IOn CirQ.. Title: 1"fa~CGt" ~reo~o-~~3 (~ <br />COmpatiy Name: Cof di~ICf yin C,.,n, Pl~a yiL(. S0f V6(, OS~ ~.f-nC.. <br />1 <br />StreeUP.O. Box: ~"Zlo 21 'Z IC oI _ P.O. Box: __ <br />City: ~~wnd ~w,.~~,~ <br />stare: i/ D <br />Telephone Number: (~ ~ O ) - .L ~ <br />Fax Number: ( `x`70 )-_~(n <br />CC: STAT6ORFF.DERALLANDOWNER(ifany] <br />Agency: __ ~~' <br />Stree[: <br />City: <br />State: <br />Telephone Ntunbee 1 )- <br />CC: STATE OR FEDERAL LANDONNF.R (if anv) <br />Agency: <br />Street: <br />City: _~ <br />State: <br />Telephone Number <br />Slate: GC7 Zip Code: c'3 I S O I <br />Telephone Number: 7 0 - 2 (0 3-~ a ~ D <br />FaxNUmber. (Cr~O )- 2!0 3 -~y S~(a <br />City: I,TCPn _ Jand~o~~C//AnS~-on <br />State: C ~. I/`) l <br />Telephone Number: (30`7 )_ (0'7-]-~(onp~ <br />Fax Number: ( ) - <br />PERMITTRvGCONTACT (if different from applinea~M/operator above) <br />Contact's Name: /+ W:I I ~~wvl Moq ('vff, <br />CorttpanyNattte: CpfOillQ(G~n COM~jia/LCC_ Se <br />Street/P.O. Box: g Z Co 2- ( i2 R ~ <br />City: ~Sfanl/ Jwr,~~,a.~ <br />Title: 1 ~a 1 L GY ~' GO I o ~1 S~ <br />~~- <br />P.O. Box: <br />Zip Code: ~'i I SU ~ <br />(o <br />Title: S~~C Sup~+(`ig~~e.nE' <br />enrar~- <br />Box: <br />Zip Code: ~ ~ O S~ <br />a_Q..nc" <br />Z.ip Cnde: <br />Zip Code: <br />