2017-01-03_REVISION - M1997015

• Permit No: M1997015
• IBM Index Class Name: Revision
• Doc Date: 1/3/2017
• Doc Name: Request For Amendment To Permit
• From: Washington County
• To: DRMS
• Type & Sequence: AM2
• Email Name: ECS
• Email Name: WHE
• Media Type: D
• Archive: No

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11. Corresimndence Informatloa:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: Jason LDckard
Company Name:
Street/P.O. Box:
City:
State:
Washington County
title: Road Supervisor
501 4th Avenue P.O. Box:
Akron
CO Zip Code: 80743
Telephone Number. ( 970 1 _ 246-3347
Fax Number: ( 970 1-246-3347
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: Randy Schafer Title:
Company Name:
Street/P.O. Box:
40586 Co. Rd. 21
P.O. Box:
City:
Haxtun
State:
CO
Zip Code: 80731
Telephone Number:
( 970 1- 520-0502 (Cell)
Fax Number:
(970 1-854-3811
INSQECTION CONTACT
Contact's Name:
Jason Loekard
Title:
Company Name:
Street/P.O. Box:
P.O. Box:
City:
SAME AS ABOVE
State:
Zip Code:
Telephone Number:
f
Fax Number:
( 1 -
CC: STATE OR FEDERAL
LANDOWNER (if any)
Agency:
Street:
City:
State:
Zip Code:
Telephone Number:
L ) -
CC: STATE OR FEDERAL_
LANDOWNER (if any)
Agency:
Street:
City:
State:
Zip Code:
Telephone Number: