2017-09-15_PERMIT FILE - M2017046

• Permit No: M2017046
• IBM Index Class Name: PERMIT FILE
• Doc Date: 9/15/2017
• Doc Name Note: new application
• Doc Name: Application
• From: Gary W. Pollack
• To: DRMS
• Email Name: ERR
• Email Name: WHE
• Media Type: D
• Archive: No

-2 -
9. Correspondence Information:
APPLICANT/OPERATOR (name, address,and phone of name to be used on permit):
Contact's Name: -4 k-'( / LL,4 r'�_ Title:a f'� (7 VV// 7
/ `7
Company Name:
Street: _ • . P.O. Box: 6,0a. 3
City: .rj a4 e , .)c PA/J✓Q-S
State: __, CO"LC/AA-Po Zip Code:_1301-5';
Telephone Number: ( 7 oL ) - < Cc7‘3. --(3—(g,(13
Fax Number: ( ) -
PERMITTING CONTACT (if different from applicant/operator above):
Contact's Name: Title:
Company Name:
Street: P.O.Box:
City:
State: Zip Code:
Telephone Number: ( ) -
Fax Number: ( ) -
INSPECTION CONTACT:
Contact's Name: ,54 vY/ cr fls , BCYa- Title:
Company Name:
Street: P.O. Box:
City:
State: Zip Code:
Telephone Number: ( ) -
Fax Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER(ififN any): r
Agency: c_50 • i 1'' R/4 6- L 1 6 7/z/ G7
Street: f, d , i3 O S< 21 ?
City: P4lR •PL4�j co
State: CDL-0/Z 400 Zip Code:
Telephone Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER(if any):
Agency: N. A
Street:
City:
State: Zip Code:
Telephone Number: ( ) -