2015-04-13_REPORT - M1997100

• Permit No: M1997100
• IBM Index Class Name: REPORT
• Doc Date: 4/13/2015
• Doc Name: Application AM01
• From: Branson Gravel Pit
• To: DRMS
• Type & Sequence: AM1
• Email Name: AME
• Email Name: TAK
• Media Type: D
• Archive: No

-3-
11. Corresoondenee Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contacts Name: Gwy D. HE Title: Board of Commissioners Chairman
Company Name: Las Animas County
Street/P.O. Box:
City:
State:
200 E. 1 st Street Room 110
P.O. Box:
Trinidad
Colorado Zip Code: 81082
Telephone Number:
( 719 1-846-2568
Fax Number:
( 719 1-846-2698
PERMI'[M CONTACT
(if different from applicant/operator above)
Contacts Name:
Phil Dorenkamp Title:
C N
Las Animas County
ompany ame.
Street/P.O. Box:
City:
State:
Telephone Number
Fax Number:
INSPECTION CONTACT
Contacts Name:
Company Name:
Street/P.O. Box:
City:
State:
2000 N. Linden Ave
Trinidad
P.O. Box:
Colorado Zip Cam: 81082
r 719 _ 846 -2931
( 719 1-846-0434
-
Dorenkamp Title:
Telephone Number. ( ) Fax Number. ( ) -
CC: STATE OR FEDERAL LANDOWNER (if anv)
Agency:
Street:
P.O. Box:
Zip Code:
City:
State: Zip Code:
Telephone Number. ( ) -
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State:
Telephone Number:
Zip Code: