2016-09-19_REVISION - M2003024

• Permit No: M2003024
• IBM Index Class Name: REVISION
• Doc Date: 9/19/2016
• Doc Name: Request For Amendment To Permit
• From: Phillips County
• To: DRMS
• Type & Sequence: AM1
• Email Name: ERR
• Email Name: WHE
• Media Type: D
• Archive: No

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11. Correspondence Information:
APPLICANT/OPERATOR (name,address,and phone of name to be used on permit)
Contact's Name: Randy Schafer Title: Administrator
Company Name: Phillips County
Street/P.O.Box: 221 S. Interocean Avenue P.O.Box:
City: Holyoke
State: Co Zip Code: 80734
Telephone Number: (970 )_ 854-3778
Fax Number: (970 )_ 854-3811
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: Same as above Title:
Company Name:
Street/P.O.Box: P.O.Box:
City:
State: Zip Code:
Telephone Number: ( )Fax Number: ( )-
INSPECTION CONTACT
Contact's Name: Same as above Title:
Company Name:
Street/P.O.Box: P.O.Box:
City:
State: Zip Code:
Telephone Number: ( )-
Fax Number: ( )-
CC: STATE OR FEDERAL LANDOWNER(if any)
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( )-
CC: STATE OR FEDERAL LANDOWNER(if any)
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( )-