2015-02-02_REVISION - M1992045 ‎(3)‎

• Permit No: M1992045
• IBM Index Class Name: REVISION
• Doc Date: 2/2/2015
• Doc Name: Application CN01
• From: Gold Basin, LLC
• To: DRMS
• Type & Sequence: CN1
• Email Name: DMC
• Media Type: D
• Archive: No

-3-
13. Correspondence Information:
APPLICANT /OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name:
Laurens Leffingwell
Title: Member
Company Name:
Gold Basin Mine
Street/P.O. Box:
1700 Wadsworth Road
P.O. Box:
City:
Old Mill Creek
State:
Illinois
Zip Code: 60083
Area Code:
( 847 ) Telephone: [phone]
Fax Number:
( ) Telephone:
PERMITTING CONTACT
(if different from applicantloperator above)
Individual's Name:
George M.L. Robinson
Title: Principal
Company Name:
R Squared, Inc
Street/P.O. Box:
3926 North State Hwy 67
P.O. Box:
City:
Sedalia
State:
CO
Zip Code: 80135
Area Code:
( 303 ) Telephone: [phone]
Fax Number.
( ) Telephone:
INSPECTION CONTACT
Individual's Name:
See Permitting Contact
Title:
Company Name:
Street/P.O. Box:
P.O. Box:
City:
State:
Zip Code:
Area Code:
( ) Telephone:
Fax Number:
( ) Telephone:
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Not Applicable
Street:
City:
State:
Zip Code:
Area Code:
( ) Telephone:
CC: STATE OR FEDERAL
LANDOWNER (if any)
Agency:
Not Applicable
Street:
City:
State:
Zip Code:
Area Code:
( 1 Telephone: