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-3- <br />11. Correspondence Information: <br />APPi..ICAN'TlOPF_RA'.fOR (name, address, and phone of name to be used on permit) //~~ <br />Contact's Nance: ~ C _Q~ ?1dC1~ Title: `OirtP ~~Q, ~lS~~-e)' <br />~. ~ _ <br />Company Name: <br />StreetlP.O. Box: 777 <br />City: <br />State: <br />P.O. Box: ~ ~v2 D <br />Zip Code: /l /o2~S <br />`Telephone Number. ~ (9 ~ - _02 7 S' ~ ~D ~ ___ <br />Fax Number: ~~. - 02.7 S ' ~~ ~ ~ _ _ <br />PF,R.A!iiTTING COi~ITACf (if different from applica~nt///operatorcbove) <br />Contact's Name: % / rYl -D 'fl2l~] /~ / ~ SC'LI.f7 ~~~ `Title: ~ Y1~G ~~'Q.vl7` <br />Company Name: <br />StreeL'P.O..Box: <br />City: <br />State: <br />Telephone Nuimber: <br />Fax Number: <br />INSPECTION COi`iTACT <br />Contact's Name: <br />Company Nance: <br />StreedP.0. Box: <br />City: <br />State: <br />P.O. Box: ~ .~ <br />'1.,ip Code: ~/ l7 / <br />~.ut l -Sf'/ L~D/I Z~1 '~ ~' `Tide: ~~~~ /~ (~ o tiCr <br />NQ/ DP t5 Q.(~i M Ct~tn~~/~i ~ ~i.l~ 1 n.~' <br />R.3 9 /~I ~~~.iY 17~J-C P.O. Box• ~ Ti2D <br />~Gw1 D/! ~~ ~f~, <br />Zip Code: ~ ~.2/S <br />'Celephone Number: ( '? / q ) _ ~ 7S' ~on?/~D _ «_ <br />Fax Number; ~ / - ~ 7 ~ ' 8~9 <br />CC_STATF, OR Fi;DERAL LAND~WN_F.,R i~f an ~ ,~~ <br />Agency: -_~TL~'L~_ y~~~? _....._ ~......_... (~~ .~?: --- Ckiv_I_ ~ ~'-~___6~~11-~-----.._.._.._ <br />Street: --_-- ~~~___.C~ ~.~2~.._..._.__._._._...__.._~ _...------.#-i-Q ~..._~~.x __.. ~ ~.~ ._._.___.._..._.......-..._-.----- <br />t..",ity: <br />State: <br />lip {`ocle: <br />'t'elephone Number: 4.. ~~.----._..) - ---._ --~'~..°~4---~.._-.ter.®_.... __..._. _ . <br />('(;'_„_STA"I'E_nR. FFit7E'sR~L I.ANI)C7W~_R ~ifany~ <br />Agency: <br />Street: <br />City: <br />State: _ lip t;ode: <br />'Telephone Nrt,~tYber: ~._._._._..._....___._.__-..~. - __._._...____._.._.._...__..------._..-......----.___.------..--..-- -- .._...._.. __... _. _. _..._ <br />