2019-02-22_PERMIT FILE - M2019010

• Permit No: M2019010
• IBM Index Class Name: PERMIT FILE
• Doc Date: 2/22/2019
• Doc Name: Application
• From: John Kuijvenhoven
• To: DRMS
• Email Name: THM
• Email Name: WHE
• Media Type: D
• Archive: No

-2-
11. Correspondence Information:
APPLICANT/OPERATOR (name,address,and phone of name to be used on permit)
Contact's Name: John Kuijvenhoven Title:
Company Name:
Street/P.O.Box: 6124 County Road 5 P.O.Box:
City: Ridgway
State: Colorado Zip Code: 81432
Telephone Number: (970 )_ 417-0177
Fax Number: ( 1-
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: Title:
Company Name:
Street/P.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 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-