2021-07-27_REVISION - M1977300

• Permit No: M1977300
• IBM Index Class Name: Revision
• Doc Date: 7/27/2021
• Doc Name Note: AM-6 Completeness Response
• Doc Name: Completeness Response
• From: Colorado Legacy Land
• To: DRMS
• Type & Sequence: AM6
• Email Name: AME
• Email Name: MAC
• Media Type: D
• Archive: No

-4-
14. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit):
Contact's Name: Title:
Company Name:
Street: P.O. Box:
City:
State: Zip Code:
Telephone Number: ( ) -
Fax Number: ( ) -
PERMITTING CONTACT (if different from applicant/operator above):
Contact's Name: Title:
Company Name:
Street: P.O. Box:
City:
State: Zip Code:
Telephone Number: ( ) -
Fax Number: ( ) -
INSPECTION CONTACT:
Contact's Name: Title:
Company Name:
Street: 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: ( ) -