2016-11-30_REVISION - M2011017

• Permit No: M2011017
• IBM Index Class Name: REVISION
• Doc Date: 11/30/2016
• From: DRMS
• To: various
• Type & Sequence: SR1
• Email Name: ACY
• Media Type: D
• Archive: No

-2-
11. Correspondence Information:
APPLICANT/OPERATOR (name,address,and phone of name to be used on permit)
Contact's Name: Rick Domson Title: Sec/Treas _
Company Name: Breeze Basin Resources
Street/P.O. Box: P.O. Box: 181
City: Hayden
State: c0 Zip Code: 81639
Telephone Number: ( 970 326-8689
Fax Number: ( 979 )_ 824-2840
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: Title:
Company Name:
Street/P.O. Box: P.O. Box:
City:
State: Zip Code:
Telephone Number: ( )Fax Number: ( -
INSPECTION CONTACT
Contact's Name: Rick Domson Title: Sec/Treas .
Company Name: Breeze Basin Resources
Street/P.O.Box: P.O. Box: 181
City: Hayden
State: co Zip Code: 81639
Telephone Number: ( 970 )- 3 2 6—8 6 8 9
Fax Number ( 970 )- 824-2840
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: ( 1-