PERMFILE53502

• Permit No: M2005044
• IBM Index Class Name: PERMIT FILE
• Doc Date: 7/14/2005
• Doc Name: limited impact operation
• From: lincoln county
• To: dmg
• Email Name: MAC
• Media Type: d
• Archive: No

-3-
14. Corresooodentt Information:
APPLICANT/OPERATOR (name, address, and phone of name [o be used on permit)
Contact's Name: Don Blake Title: T.an~9 TTGP Adm_
Company Name: Lincoln County
Street/P.O. Box: 10 3 3rd Ave P.O. Box: _3 9
City: Huao
State: Colorado Zip Code: 8Q8 21
Telephone Ntunber: (719 1- 7 4 3- 2 3 3 7
Fax Number: (719 ~- 7 4 3- 2 8] 5
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name:
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number:
Fax Number:
INSPECTION CONTACT
Contact's Name:
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number:
Fax Number:
CC: STATE OR FEDERAL LANDOWNER (if anyj
Agency:
Street:
City:
State:
Telephone Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER (if an
Agency:
SVeet:
CiTy:
State:
O. Box:
Zip Code:
Don Blake Title: Lard Usa AcTm-
Lincoln County
P.O. Box:
Zip Code:
X719 )-
( 719 )-
Zip Code:
Zip Code:
Telephone Number ( 1-