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-3- <br />11. Correspondence information: <br />APPLICANT/OPERATOR (name, address, and phone of name to be used on permit) <br />Contact's Name: Le,r'ry L v <br />---------------- Title: 0 <br />Company Name: cc, rok r^ C% Y3 ? T??? <br />Street/P.O. Box: ., 0 l b c` P.O. Box: <br />? <br />City: _ C CC --- <br />State: _ Zip Code: g '= S- <br />Telephone Number: ! o ) - ?4 - 3 s •? <br /> <br />Fax Number: <br /> <br />PERMITTING CONTACT (if different from applicantloperator above) <br />Contact's Name Title: <br />Company Name: n ?-e t 5 C S <br />StreetiP.O. Box: P.O. Box: <br />City: <br />State: G Zip Code: ?d l <br /> <br />3 `? - 7 3 S-P <br />Telephone Number: j `110 } - <br />? <br />Fax Number: ) - <br /> <br />INSPECTION CONTACT <br />Contact's Name: Title: <br /> <br />Company Name: <br /> <br />Street/P.O. Box: P.O. Box: <br /> <br />City: <br /> <br />State: Zip Code: <br /> <br />Telephone Number: ( ) - <br /> <br />Fax Number: ( ) - <br /> <br />CC: STATE OR FEDERAL LANDOWNER if an <br />Agency: <br /> <br />Street: <br /> <br />City: <br /> <br />State: Zip Code: <br />------------ - <br />Telephone Number: L <br />j - <br />_ --- <br />CC: STATE OR FEDERAL LANDOWNER (ifanY) <br />Agency: - - <br /> <br />Street: <br /> <br />City: -? _-__ - __ <br />- _ _- --- ---- <br />State: Zip Code: <br /> <br />Telephone Number: (._--------- <br />?_