2010-12-07_REVISION - M1990134 ‎(7)‎

• Permit No: M1990134
• IBM Index Class Name: REVISION
• Doc Date: 12/7/2010
• Doc Name: 110c Amendment Application
• From: Jim H. Ross and Kathleen H. Ross
• To: DRMS
• Type & Sequence: AM1
• Email Name: DMC
• 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: r..11ad \„ ps ut 12us5 ,t. UN t l Q4-\ ti . ?DSS - Title:
.? ?- ` ` ?
Company Name:
P.O. Box:
Street/P.O. Box:
City:
Zip Code:
State: g s?
(
pb^ ]\- 4 ?j?I
Telephone Number:
Fax Number: c,,?d ?-!? - ,Ac - 3 I un
PERMITTING CONTACT (if different from applicant/operator above
Contact's Name: ? ?k ' Title:
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number:
Fax Number:
INSPECTION CONTACT
Contact's Name:
Company Name:
Street/P.O. Box:
0-
P.O. Box:
Zip Code:
q10 39-c-SS??
?- &A,LI- G4 t0
Title: '
P.O. Box:
City: // --
Zip Code: ? 1(.D
State:
Telephone Number: A10?
Fax Number: l l D --i-
CC: STATE OR FEDERAL LANDOWNER (if anvl
Agency: bou
Street:
City:
State:
Telephone Number: -
Agency:
Street:
City:
State:
Telephone Number:
Zip Code:
Zip Code: