2018-09-21_REVISION - M2010036

• Permit No: M2010036
• IBM Index Class Name: REVISION
• Doc Date: 9/21/2018
• Doc Name: Request For Amendment To Permit
• From: Rick Ensminger
• To: DRMS
• Type & Sequence: AM1
• Email Name: ERR
• Email Name: MAC
• Media Type: D
• Archive: No

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11. Correspondence Information:
APPLICANT/OPERATOR (name,address,and phone of name to be used on permit)
Contact's Name: Rick Ensminger Title: Owner/operator
Company Name:
Street/P.O.Box: P.O.Box: PO Box 276
City: Haxtun
State: CO Zip Code: 80731
Telephone Number: (970 1. 774-6108
Fax Number: ( )-
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 _ 854-3778 (work), 970-520-0502 (Cell), 970-774-6264 (home)
Fax Number: (970 )_ 854-3811
INSPECTION CONTACT
Contact's Name: Rick Ensminger Title:
Company Name:
Street/P.O.Box: SAME AS ABOVE P.O. Box:
City:
State: Zip Code:
Telephone Number: ( )Fax Number: ( )-
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-