PERMFILE138195

• Permit No: M1977479
• IBM Index Class Name: Permit File
• Doc Date: 10/3/1977
• Doc Name: LIMITED IMPACT & SPECIAL TEN DAY PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

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NOTICE PROCEDURES
After t;;e application has bee;; filed wttli t~;e Division, not ice pro-
cedures outlined in Section 3.2 or 4.2 !whichever is appl:cable~ masr, be
followed.
ADDITIONAL INFOR,'tATION
This space can be referenced fur futtV;er information of airy of tl;e items
on this form.
To the best of my knowledge, all the Information presented in this application
is true and correct.
BY ~ ,~^~'
Title: ~
(Signed by individual legally authorized
to bind the operator to th~.s application)
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