2015-03-05_REVISION - M1986074

• Permit No: M1986074
• IBM Index Class Name: REVISION
• Doc Date: 3/5/2015
• Doc Name: Application CN01
• From: Kym Schure
• To: DRMS
• Type & Sequence: CN1
• Email Name: ERR
• Email Name: TAK
• Media Type: D
• Archive: No

-3-
11. Correspondence Information:
APPLICANT/OPERATOR
(name, address, and phone of name to be used on permit)
Contact's Name:
KYm Sctxwe
Title: Owner
Company Name:
Street/P.O. Box:
12826 Co. Rd. 37
P.O. Box:
City:
Sterling
State:
CO
Zip Code: 80751
Telephone Number:
( 970 1-520-6808
Fax Number:
( -
PERMITTING CONTACT
(if different from applicantloperator above)
Contact's Name:
Randy Schafer
Title:
Company Name:
Street/P.O. Box:
40586 Co. Rd. 21
P.O. Box:
City:
Haxtun
State:
CO
Zip Code: 80731
Telephone Number:
( 970 ) _ 774 -6264 (home); 970 - 520 -0502 (Cell); 970 - 854 -3778 (Work)
Fax Number:
( 970 _ 854 -3811
INSPECTION CONTACT
Contact's Name:
Same as the Applicant/Owner
Title:
Company Name:
Street/P.O. Box:
P.O. Box:
City:
State:
Zip Code:
Telephone Number:
(
Fax Number:
( 1-
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:
( 1-