PERMFILE55037

• Permit No: M2004036
• IBM Index Class Name: Permit File
• Doc Date: 5/5/2004
• Doc Name: 110c Appl
• From: Mason King
• To: DMG
• Media Type: D
• Archive: No

-3-
14. Correaoondence Informatbn:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: Mason Kine Title: Owner/Operator
Company Name:
Street/P.O. Box: 6455 . Co . Rd r %X p.O. Box; 68
City: Cope
State: ro Zip Code: 80812
Telephone Number: ( 97(1 1- 357-4945
Fax Number: L 970 1- 357-4349
PERMITTING CONTACT (if different from applicant/aperator above)
Contact's Name: Randy Schafer Title: Consultant
Compaq Name:
Street/P.O.Box: 40586 Co. Rd. 21 P.O.Box:
City: Haxtun
State: CO Zip Code: 80731
Telephone Number: (970 1- 854-3778 (Office) 970-774-6264 (Home)
Fax Number: (970 ~_ 854-3811
INSPECTION CONTACT
Contact's Name:
Compaq Name
Street/P.O. Box:
City:
State:
Mason Kine Title:
INFORMATION SAME AS APPLICANT?OPERATOR
P.O. Hox:
Zip Cade:
Telephone Number: ( 1-
Fax Number. ( 1-
CC: STATE OR FEDERAL LANDOWNER (if aml
Agency: N/A
Street:
City:
State:
Telephone Number
Zip Code:
CC: STATE OR FEDERAL LANDOWNER (if ~
Agency: N/A
Stree[:
City:
State:
Telephone Numbet
Zip Code: