1999-08-23_GENERAL DOCUMENTS - C1981017

• Permit No: C1981017
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 8/23/1999
• Doc Name: Bid Documents ‎(IMP)‎
• Permit Index Doc Type: General Correspondence
• Media Type: D
• Archive: No

ATTACHMENT C
REQUEST FOR AVS RECOMMENDATION
REQUESTS SHOULD BE MAILED TO: MR. KEITH HARRISON
AVS RECOMMENDATION COORDINATOR
OFFICE OF SURFACE MINING
2679 REGENCY ROAD
LEXINGTON, KENTUCKY 40505-42 1 5
REQUESTS SHOULD BE FAXED TO: [phone]
ATTENTION: KEITH HARRISON
REQUESTS THAT ARE PHONED IN: [phone] (DIRECT)
1 -800-643-9748
/ KEITH
HARRISON
I REQUESTING OFFICE:_ DATE: w
NAME: C PHONE NoG
FAX No.� �)_g3 s}/ate
2. CONTRACTOR INFORMATION:
NAME: ✓"z'
ADDRESS: 7/ `7— // t�//�Y
PHONE No: �70r J7SS- /OC
EMPLOYEE ID:
SUBCONTRACTOR INFORMATION:
NAME:
ADDRESS:
PHONE No:
SSN OR TIN:
INSPECTOR INFORMATION: IF NOT PART OF THE ABOVE COMPANIES
NAME:
ADDRESS:
PHONE NO:
SSN OR TIN:
*FOR EMERGENCY RECOMMENDATIONS, THE OWNERSHIP AND CONTROL DATA
CERTIFICATION INFORMATION SHOULD BE INCLUDED WITH THE REQUEST.