PERMFILE47460

• Permit No: M1987026
• IBM Index Class Name: Permit File
• Doc Date: 2/19/1987
• Doc Name: LIMITED IMPACT OPERATION 110 APPLICATION FORM
• Media Type: D
• Archive: No

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10. Correspondance Information
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit.)
Individual's Name: Ri11 Tezax
Company Name: co l_~rado Onarriec, Tnc.
Street: 15th R Water Stc_ P.O_ Rox 13R9
City: saw,., r; r~
State: c~1~ra~1~ Zip Code• R1~1~
Area Code: • Telephone:f
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
INSPECTION CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
State: Zi p Code:
Area Code: Telephone:
11: Primary future ^ Cropland(CR) ^ Pastureland(PL) ^ General Agriculture(GA)
land use ® Rangeland(.RL) ^ Forestry(FR) ^ Wildlife Habitat(WL)
(check one): ^ Residential(RS) ^ Recreation(RC) ^ Industrial/Commercial(IC)
^ Developed Water Resources(WR) ^ Solid Waste Disposai(WD)
12. Primary present ^ Cropland(CR) ^ Pastureland(PL) ^ General Agriculture(GA)
land use ® Rangeland(RL) ^ Forestry(FRi ^ Wildlife Habitat(WL)
(check one): ^ Residential(RS) ^ Recreation(RC) ^ Industrial/Commercial(IC)
^ Developed Water Resources(WR)
To the best of my knowledge, all the information presented on this application form and
the attached/Exhibits A-G are true and correct (m .t be signe~dib~y applicant/operator).
Date: ~1~ ~li - ~, By: .~cLj~~~s-~(/
President
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