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-2- <br />11. Correspondence Information: <br />APPLICANT/OPERATOR (name, address, <br />and phone of name to be used on permit) <br />li <br />Contact's Name: R ly .i r__ "t S Title: G otf> <br />Company Name: b ! '/ ia» - ` "'E' ^ <br />Street/P.O. Box: ej .0. Box: <br />City: ?il"c t% <br /> <br />State: C_ / s <br />Zip Code: <br />Telephone Number: Zy <br /> <br />Fax Number: ( ) - <br />PERMITTING CONTACT (if different from applicant/operator above) <br />' <br />?'t??' <br />r <br />Contact <br />s Name: <br />?7??a Title: <br />Company Name: <br />Street/P.O. Box: P.O. Box: P <br />City: t? G 1'qQ, <br />State: Zip Code: V llp <br />Telephone Number: 3Z4,--- 7 S ? <br />(c,e ff <br />/0 <br />Fax Number: ( ) - <br />INSPECTION CONTACT <br />Contact's Name: Title: <br />Company Name: <br /> <br />Street/P.O. Box: P.O. Box: <br />City: <br /> <br />State: Zip Code: <br />Telephone Number: ( ) - <br /> <br />Fax Number: ( ) - <br />CC: STATE OR FEDERAL LANDOWNER (if any) <br />Agency: <br /> <br />Street: <br />City: <br /> <br />State: Zip Code: <br />Telephone Number: ( ) - <br /> <br />CC: STATE OR FEDERAL LANDOWNER (if any) <br />Agency: <br /> <br />Street: <br />City: <br /> <br />State: Zip Code: <br />Telephone Number: ( ) -