REP18714

• Permit No: M1977170
• IBM Index Class Name: Report
• Doc Date: 11/12/1997
• Doc Name: CONSTRUCTION MATERIALS REGULAR 112 OPERATIONS RECLAMATION PERMIT APPLICATION FORM
• Permit Index Doc Type: ANNUAL FEE/REPORT
• Media Type: D
• Archive: No

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14
Correspondenoe Information:
APPLICANT/OPERATOR (name/,~lJ ddrle,.ss,~and
Contact's Name: //~~~/` - Y'
Company Name: ~ ~/"~~ ~.sr
f~(,
/
Street: ~
7/
/(y~ J
city: ~S/9G/09
State: ~~-d/~i90~ Zip code: ~/~~
Telephone Number: (7~~p ) - J~~ - 2a al
Fax Number: ( '~ I -f ) - .5~~~- c~SoZ~
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: Title:
Company Name:
Street:
City:
State:
Telephone Number: ~ ) -
Fax Number: ~ ) -
INSPECTION CONTACT
Contact's Name:
Company Name:
Street:
City:
State:
Telephone Number:
Fax Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER (if anv)
Agency:
Street:
City:
State:
Telephone Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State:
Telephone Number:
.t)
pfNT
r~
Zip Code:
Zip Code:
Zip Code:
Gd~02~Qo Zip Code: O~yD~