2011-11-09_REVISION - M1988052 ‎(3)‎

• Permit No: M1988052
• IBM Index Class Name: Revision
• Doc Date: 11/9/2011
• Doc Name: Submittal
• From: Rick L. Hunt
• To: DRMS
• Type & Sequence: AM1
• Media Type: D
• Archive: No

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11. Correspondence Information:
APPLICANT /OPERATOR (name, address, and / phone pf name to be used on permit)
Contact's Name: e;61.
Company Name: / il ?77 I /�'a _D
Street/P.O. Box: �°y 31( / '-
City: 'i A Za. /at 14,
I
State: /0-ra GtD / / /
Telephone Number: ( „()d ) - j, </ - /� 7
Fax Number: (, ()3 ) - / 7/B ` 90
P.O. Box:
Zip Code: aa M 7
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: Title:
Company Name:
Street/P.O. Box: P.O. Box:
City:
State: Zip Code:
Telephone Number: ( ) -
Fax Number: ( ) -
INSPECTION CONTACT ^ ,'
Contact's Name: \ lr` i a Title: b p r
Company Name:
Street/P.O. Box: J � loo CO L) , ,v1 . (24 11- a' P.O. Box:
City: z0-
State: 0.6 Ic ra ei 0 Zip Code: b 1 D
Telephone Number: (37.` 3 ) - tp-`I (o - 01
Fax Number: ( :3c:2 ) - CP&1 (g" qaa J
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( ) -