2017-07-11_REVISION - M2015017

• Permit No: M2015017
• IBM Index Class Name: REVISION
• Doc Date: 7/11/2017
• Doc Name: Adequacy Review Response #2
• From: Greg Lewicki & Assoc.
• To: DRMS
• Type & Sequence: TR1
• Email Name: MAC
• Media Type: D
• Archive: No

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6. Correspondence Information:
APPLICANT/OPERATOR (name,address,and phone of name to be used on permit)
Contact's Name: MarcyBrossman Title:_County Administrator
Company Name: --Cheyenne Countv
Street/P.O.Box: 51 S. 1st P.O. Box: 5 6 7
City: Cheyenne Wells
State: Colorado Zip Code: 80810
Telephone Number: 719 }_ 767-5872
Fax Number: ( 719 }_ 767-5753
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: Title:
Company Name: �_--
StreeUP.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 N amber:
Fax Number. —
CC: STATE OR FEDERAL LANDO)VNER if anv
Agency: T
Street:
City:
State: Zip Code:
Telephone Number: ( -
CC: STATE OR FEDERAL LANDOWNT-R(if any)
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( -
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