2014-08-22_REVISION - M2005065

• Permit No: M2005065
• IBM Index Class Name: REVISION
• Doc Date: 8/22/2014
• Doc Name: Notices SR01
• From: DRMS
• To: Various
• Type & Sequence: SR1
• Email Name: WHE
• Media Type: D
• Archive: No

-3-
t 1. CoM— MMdence Information:
APPLICANT/OPERATOR. (name, address, and phone of name to be used on permit)
Contact's Name: .7a _k Clark,. Tr. Title: Oyner
Company Name:
St "VP.O. Box:
City:
State:
Telephone Number.
Fax Number.
P.O. Box- 7A 7
Silverton
Colorado Zip Code: 8 1433
( 970 )- 387-5243
PERMITTING CONTACT (if different &one applicant gw%tor above)
Conta&sName. Charles R. Ponchak Title -Geological Consultant
Company Name:
Sbvet(P.O. Box: _ 15292 6050 Rd P.O. Box:
City: Mon t ro g e
She: Colorado Zip Code: 81403
Telephone Number. 970 ) --249 -2081 970-249 -4414
Fax Number: ( 970 )-249-2081
INSPECTION CONTACT
Contacts Name: _ Jack f! 1 a rk , ,Tr- Title• my A r
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number: ( Fax Numbs: ( ) -
CC: STATE OR FEDERAL LANDO (if !W
Agency:
Street:
City:
State:
Telephone Number. ( ) -
Agency:
St vd:
City:
State:
Telephone Number.
P.O. Box:
Zip Code:
Zip Code:
Zip Code:
( 1-
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