2014-12-22_REVISION - M1994114

• Permit No: M1994114
• IBM Index Class Name: Revision
• Doc Date: 12/22/2014
• Doc Name: Notices
• From: DRMS
• To: Various
• Type & Sequence: CN1
• Email Name: TOD
• Media Type: D
• Archive: No

-3-
I I. Correspondence Information:
APPLICANT/OPERATOR (name,address,and phone of name to be used on permit)
Contact's Name: Andy Kagan Title: Owner
Company Name: Kagan and Son, LLC
Street/P.O.Box: 555 Ernest Avenue P.O.Box:
City: Westcliffe
State:
CO Zip code: 81252
Telephone Number: (719 )_ 783-9636
Fax Number: (719 )_ 783-9636
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: Ken Klco Title:
Company Name: Azurite, Inc.
Street/P.O.Box: P.O.Box: 338
City: Cotopaxi, —_
State: CO Zip Code: 81223
Telephone Number: (719 1. 942-4178,cell 719.207.3973 e-mail [e-mail]
Fax Number: (719 )_ 942-4178 q�
INSPECTION CONTACT
Contact's Name: Andy Kagan Title: Owner
Company Name: Kagan and Son, LLC
Street/P.O.Box: 555 Ernest Avenue P.O.Box:
Westcliffe
City:
State: CO zip Code: 81252
Telephone Number: (719 - 783-9636
Fax Number: (719 )_ 783-9636
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: ( -