2016-01-29_PERMIT FILE - M2016002 ‎(2)‎

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

-2-
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:
State: Colorado Zip Code: 80454
Indian Hills
Telephone Number:
Fax Number:
(303
(
1
)
_ 898-7539
PERMITTING CONTACT (if different from applicant/operator above):
Ian Merkel
Contact's Name:
Company Name:
Street: 2711 Fillmore Street P.o. Box:
Title: Geologist
City: Denver
State: Colorado Zip Code: 80205
Telephone Number: ( 303 ) _ 859-8924
Fax Number: ( 1 -
1p1SPECTION CONTACT:
Contact's Name: Title:
Company Name:
Street: P.O. Box:
City:
State: Zip Code:
Telephone Number. ( 1
Fax Number: ( 1
CC: STATE OR FEDERAL LANDOWNER (if any):
Agency: USDA Amy Titterington
Street: 320 Highway 285
City: Fairplay
State: Colorado
Telephone Number:
(719
_ 836-3871
Zip Code: 80440
CC: STATE OR FEDERAL LANDOWNER (if any):
Agency:
Street:
City:
State: Zip Code:
Telephone Number. ( 1 -