2015-02-11_REVISION - M1992045

• Permit No: M1992045
• IBM Index Class Name: REVISION
• Doc Date: 2/11/2015
• Doc Name: Notices CN01
• From: DRMS
• To: various
• Type & Sequence: CN1
• Email Name: DMC
• Media Type: D
• Archive: No

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