2017-11-08_REVISION - M1983139

• Permit No: M1983139
• IBM Index Class Name: Revision
• Doc Date: 11/8/2017
• Doc Name: Request For Amendment To Permit
• From: Pioneer Sand
• To: DRMS
• Type & Sequence: AM1
• Email Name: MAC
• Email Name: WHE
• Media Type: D
• Archive: No

-3-
11. Correwondence InfarMation:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: James Sullivan Title: Director of Utilities
Company Name: The City of Arvada
Street/P.O. Box: 8101 Ralston Road P.O. Bow 8101
City:
State:
Arvada
Colorado
Zip Code: 80002
Telephone Number ( 720 ) _ 898-7760
Fax Number: ( ) -
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: James Sullivan Title: Director of Utilities
Company Name: The City of Arvada T _
Streaw.O. Box: 8101 Ralston Road P.O. Box: 8101
City:
State:
Telephone Number.
Fax Number.
INSPECTION CONTACT
Contact's Name:
Company Name:
Street/P.O. Box:
City:
State:
Arvada
Colorado
L 720 _ 898-7760
Zip Code:
80002
James Sullivan Title: Director of Ut€Iities
The City of Arvada
8101 Ralston Road P.O. Box: 8101
Arvada
Colorado
Telephone Number: ( 720 898-7760
Fax Number: ( 1 -
Zip Code: 80002
Agency:
NIA
street:
NIA
city:
NIA
State:
NIA Zip Code: NIA
Telephone Number.
( 1- NIA
CC: STATE OR FEDERAL
Agency:
LANDOWNER (if envl
NIA
Street~
NIA
city.
NIA
State:
NIA Zip code: NIA
Telephone Number.
r ] - NIA