2016-01-29_PERMIT FILE - M2016002

• Permit No: M2016002
• IBM Index Class Name: Permit File
• Doc Date: 1/29/2016
• Doc Name: Application
• From: Donald J. Self
• Email Name: TC1
• Email Name: WHE
• Media Type: D
• Archive: No

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9. Correspondence Information:
APPLICANT/OPERATOR (name,address,and phone of name to be used on permit):
Contact's Name: Donald J. Self Title: Owner
Company Name:
Street:P.O.Box: 473
City: Indian Hills
State: Colorado Zip Code: 80454
Telephone Number: 303 898-7539
Fax Number:
PERMITTING CONTACT (if different from applicant/operator above):
Contact's Name: Ian Merkel Title: Geologist
Company Name:
Street: 2711 Fillmore Street P.O.Box:
City: Denver
State: Colorado Zip Code: 80205
Telephone Number: 303 859-8924
Fax Number:
INSPECTION CONTACT:
Contact's Name: Title:
Company Name:
Street:P.O.Box:
City:
State: Zip Code:
Telephone Number:
Fax Number:
CC: STATE OR FEDERAL LANDOWNER(if any):
Agency: USDA Amy Titterington
Street: 320 Highway 285
City: Fairplay
State: Colorado Zip Code: 80440
Telephone Number: 719 836-3871
CC: STATE OR FEDERAL LANDOWNER(if any):
Agency:
Street:
City:
State: Zip Code:
Telephone Number: