2019-10-04_REVISION - M1999007

• Permit No: M1999007
• IBM Index Class Name: REVISION
• Doc Date: 10/4/2019
• Doc Name: Request for Conversion of Permit
• From: Weldon Construction
• To: DRMS
• Type & Sequence: CN1
• Email Name: DMC
• Email Name: THM
• Media Type: D
• Archive: No

-3-
11. Correspondence Information:
APPLICANT/OPERATOR (name,address,and phone of name to be used on permit)
Contact's Name: 1164ke Weldon Title: Owner
Company Name: Weldon Construction, LLC
Street/P.O.Box: PO Box P.O.Box: 1170
City: Vernal
State: Utah Zip Code: 84078
Telephone Number: (435 _ 828-3329
Fax Number: ( )-
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: ( 1-
INSPECTION CONTACT
Contact's Name: Title:
Company Name:
Street/P.O.Box: P.O.Box:
City:
State: Zip Code:
Telephone Number: (Fax Number: ( 1-
CC: STATE OR FEDERAL LANDOWNER(if any)
Agency: Bureau of Land Management
Street: 220 E. Market St.
City: Meeker
State: Colorado Zip Code: 81641
Telephone Number: (970 _ 878-3800
CC: STATE OR FEDERAL LANDOWNER(if anv)
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( )-