2012-06-05_PERMIT FILE - M2012027 ‎(4)‎

• Permit No: M2012027
• IBM Index Class Name: PERMIT FILE
• Doc Date: 6/5/2012
• Doc Name: 112 RECLAMATION PERMIT APPLICATION
• From: B&L COGAN, LLC
• To: DRMS
• Email Name: TAK
• Media Type: D
• Archive: No

11. Correspondence Information:
APPLICANT /OPERATOR (name. address. and . one of name to be us %d on perm
Contact's Name:
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number:
Fax Number:
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: ode.
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:
Telephone Number:
( i7I`f )- 5 ant i-
Fax Number: ( f -
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State:
Telephone Number:
N l�
CC: STATE OR FEDERAL LANDOWNER (if anv)
AJ IA-
Agency
Street:
City:
State:
Telephone Number:
- 3 -
BrICO
qtys A
GO
gC)O U , S tho aJ 3S P.O. Box:
rOd0 Zip Code: $Z1 1)
( `71 a )- - 2Cit
( ) -
Laur}-e Jacc1Y)
C Q C y L -
� age S
A ` V t
CAC
Title:
P.O. Box:
Zip Code:
-
Title:
P.O. Box:
Zip Code: f_) ;j J
Zip Code:
( )-
Zip Code: