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10, Cori-aspandance Inform tion <br />APPLICANT/OPERATOR (name, a3Uvcs�_ and phone of name to be used on permit) <br />Individual's Name: A. Walcer wise <br />Company Name- <br />StreCt: <br />C;ty: <br />State: <br />Area Code; <br />Puma i INS CONTACT <br />zKLtle Mountain Resources, <br />.531 _C:lay street, 42nd r --Loo; <br />iiou7tyn <br />rcxas Zip Code: 77002 <br />(/Is) Telephone: 650-6evu <br />(if different from appticant/operator above) <br />Indiviaual's Nome= <br />Company Name: <br />Szreez: <br />City: <br />State: <br />Area Code: <br />Same <br />Telephone: <br />Zip Code: <br />INSPECTION CONTACT (it d;fferent from applicant/ope,ator above) <br />Individual's <br />Name: Gary yonsoaa <br />Company Name: <br />Barrle Mou.ata.Li, Resources, <br />iuc. <br />Street: <br />P.O. ,pox 1buQ <br />City= <br />Alamosa <br />State: <br />Colorado Zip COac: 81A.L <br />Area Code: <br />71 1`0ephone: 572-3362 <br />11. Primary future <br />D <br />Cropland(Cx) O rastureland(PL) <br />❑ <br />wneral Agriculture(GA) <br />land use <br />a <br />Ranyaland(RL) 0 Foreszry(FR) <br />II <br />Wildlife Habitatiw(.) <br />(check one): <br />❑ <br />Residential(RS)0 Recreatiun(RC) <br />❑ <br />In3uSLr;al7Comeemial(IC) <br />❑ <br />Developed Water Resources(WR) <br />LJ <br />Svlid Va5te Disposal(Wv) <br />12. Primary preacnt <br />El <br />Cropland(CR) a Paszu.—rland(PL) <br />❑ <br />Generat xyriculture(GA) <br />land u.,c <br />E3 <br />Rangeland(RL) ❑ rorestry(FR) <br />13 <br />Wildlife Habitat(WL) <br />(checK one): <br />❑ <br />ResidCntial(RS) ❑ Recreazion(RC) <br />p <br />Industrial/Comme.LialfIC) <br />U <br />De.ctoped Water Resources(WR) <br />To the best of my knowledge, all the ;,,rivrmation presented on this application form a, -,a <br />the aTtached ExFibits A -P a,e true and correct (must be ;lgned by applicant/opelatvv). <br />r <br />Date: mil ay���/ By: / z6 ,�/.vac. <br />a�­e <br />title ' <br />