2016-04-15_PERMIT FILE - M2016002

• Permit No: M2016002
• IBM Index Class Name: Permit File
• Doc Date: 4/15/2016
• Doc Name: Notice Permit Appication Consideration
• From: DRMS
• To: Various
• Email Name: TC1
• Media Type: D
• Archive: No

9. Correspondence Information:
APPLICANVOPERATOR (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 1 _ 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 1 _ 859-8924
Fax Number: ( 1 -
INSPECTION 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 Zip Code: 80440
Telephone Number: (719 L _ 836-3871
CC: STATE OR FEDERAL LANDOWNER(if any):
Agency:
Street:
City:
State: Zip Code:
Telephone Number. ( L -