2020-02-05_REVISION - M1983050

• Permit No: M1983050
• IBM Index Class Name: REVISION
• Doc Date: 2/5/2020
• Doc Name: Request for Conversion of Permit
• From: Phillips County
• To: DRMS
• Type & Sequence: CN1
• Email Name: BFB
• Email Name: MAC
• Email Name: AWA
• 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: DAVID M(MIKE)SALYARDS Title: R&B MANAGER
Company Name: PHILLIPS COUNTY
Street/P.O.Box: 221 S INTEROCEAN AVE P.O.Box:
City: HOLYOKE
State: CO Zip Code: 80734
Telephone Number: (970 _ 466-0170
Fax Number: (970 _ 854-3811
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: LAURA L SCHROETLIN Title: DEPUTY ADMINISTRATOR
Company Name: PHILLIPS COUNTY
Street/P.O.Box: 221 S INTEROCEAN AVE P.O.Box:
City: HOLYOKE
State: CO Zip Code: 80734
Telephone Number: (970 )_ 854-3778
Fax Number: (970 _ 854-3811
INSPECTION CONTACT
Contact's Name: DAVID M (MIKE) SALYARDS Title: R&B MANAGER
Company Name: PHILLIPS COUNTY
Street/P.O.Box: 221 S INTEROCEAN AVE P.O.Box:
City: HOLYOKE
State: CO Zip Code: 80734
Telephone Number: (970 _ 466-0170
Fax Number: (970 _ 854-3811
CC: STATE OR FEDERAL LANDOWNER(if any)
Agency: BOARD OF LAND COMMISSIONERS
Street: 1313 SHERMAN ST, RM 621
City: DENVER
State: CO Zip Code: 80203
Telephone Number: (303 _ 866-3545
CC: STATE OR FEDERAL LANDOWNER(if any)
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( )-