PERMFILE134453

• Permit No: M2000059
• IBM Index Class Name: Permit File
• Doc Name: CONSTRUCTION MATERIALS LIMITED IMPACT 110 OPERATION RECLAMATION PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

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Correspoadeaoe Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
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Contact's Name: ~~'•i~rLl (-1~ l ot((/ Title: ( ~.;i;ri~'
i
Company Name: ("!i"~ Y t~-~'ii~"~
Street: f~''C C'/''! '~
city: lr (r )En//~•
State: ~l/' Zip Code: ,S/Z i ?-
Telephone Number: ( ~//r/ ) - /),~„- ~%Gy
Fax Number: ( ~~%G ) - /f 3 - ~ ~L'
PERMITTING CONTACT (if diff (e(rent from applicant/operator above)
Individual's Name: \ )DiN~ R~'~ /: /Y Z. i Title:
Company Name:
Street:
City:
State:
Telephone Number:
Fax Number:
INSPECTION CONTACT
• Individual's Name:
Company Name:
Street:
City:
State:
Zip Code:
( ) -
( ) -
J4~i nc r~ ~ < //r/i r
Zip Code:
Telephone Number: ( ) - _
Fax Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER (i£ any)
Agency: / Z(`i 1P
Street:
City:
State:
Telephone Number: ( ) - _
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency : l~ L• I ~Zi
Street:
City:
State:
• Telephone Number:
Zip Code:
•
Zip Code: