2010-04-19_REVISION - M2009077

• Permit No: M2009077
• IBM Index Class Name: REVISION
• Doc Date: 4/19/2010
• Doc Name: Amended Application
• From: Ed & Tracy Grimes
• To: DRMS
• Type & Sequence: AM1
• Email Name: MAC
• Media Type: D
• Archive: No

-2-
11. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name} to be used on permit) ^
Contact's Name: 1 a r OA& r'X l/ I Y14 YG Title: Cam/ Vl L° 1^
Company Name:
Street/P.O. Box:
City:
State:
Zip Code:
Telephone Number: l 1- `? 7 L ::y
Fax Number:
PERMITTING CONTACT (if different from applicant/operator above) -L
Contact's Name: Ay?- kcry,,LA, V-eewman ?R Title: ??}v/Cl l ?TGZ-h?
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number:
Fax Number:
INSPECTION CONTACT
Contact's Name:
Company Name:
Street/P.O. Box:
City:
State:
P.O. Box: ?1999

P.O. Box: 1 ??{ Z
it e:
\
P.O. Box:
Zip Code:
Telephone Number: ( ) -
Fax Number: ( ) -
Agency:
Street:
City:
State:
Zip Code:
Telephone Number: ( ) -
OWNER (if any)
CC: STATE OR FEDERAL LANDNA
Agency:
Street:
City:
State:
Zip Code:
Telephone Number: ( ) -
Cr - Zip Code: ???
("71q ) - \775-19314
( 'I I9 ) - `7797514