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112ii?6EE1Q01 p g15:,�3g2 MARTIN MARIETTA 4 97321643 <br /> 111R�113/ 817�ye:51 911f 46440.3 Northen Slue W.F %� 16 <br /> OR CT's. ,PL.Ah�iTNG PAGE 82 <br /> .Aaaerfca Stone . uara <br /> SomiflaWform <br /> StafYMa Z`eking CO Mail R,efwral t.b':k=4 <br /> 'rM'SL: -. t'�[3 t L� f► DATE: <br /> Prap,exty OwaarlCompl ' t ,�1 ��,a s clepbaaa I�Iumbtr;„�3 <br /> Tom ' elephoue Nltm'bat; <br /> "=V=ty St,reat a►ddr+ess: <br /> Complsiat: c <br /> UAAwqs <br /> JR—C,l ON 2; XRQMIMQ 833kS <br /> Is PrOPMtY located witbin 30000 fact of the quarry district bo NO (am.sea <br /> If YES,a COPY 01WE form,shall be sent-to ASC by either: i(�' report) <br /> 2)CER D MAM (kftp reaaipt) 3)IN PERSON nie aK� <br /> DATE complsiatrafen'ed to Amcri=Stone Company: _1�. Alt of 0Q t <br /> Who,at AM garb,the cvraplaiut referred to: �* <br /> phone: <br /> DATE the ASC report retmme& <br /> If complaint is resolved by A.BC,complete the Resolution of Complaint section bclow. <br /> If ASC report states£azluure not due to a result of query apezationtis OR the sabjtct p=vpcmty is <br /> over 3,000 feet franc the quarry district boi=darY,then a copy of complaint fame and,if <br /> applicable.ASC report shall be seat to Bnvironmcu al Ecalth. <br /> DAVE complaint form/ASC report:alerted to Rnv3to= mtal Health; <br /> Copy of 06mPlaizi form and ASC repoA sent by! 1)FAX 2)IN PBRSON <br /> Who in lxV;ha=octal Rem was the complaint refatred to: <br /> DA'C'E that complaint resalution was rmeivod from Bnvi mm=tal Health: <br /> SMaMON OF CQW <br />