PERMFILE55601

• Permit No: M1992045
• IBM Index Class Name: Permit File
• Doc Name: LIMITED IMPACT OPERATION 110 2 RECLAMATION PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

9

PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name: sar.r-:
Company Name:
Street:
City:
State: Zip Code: _
Area Code: Telephone:
C
_p_.
u
Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
•~ Individual's Name: r;m panPlla
Company Name:
Street: nn rtnv ;~ rn 3~i _
C1 ty: NATHi20P
State: COLOH;LDO Zip Code: 81236
Area Code: 219 Telephone: [phone]
INSPECTION CONTACT
Individual's Name:
Company Name:
Street:
City:
State:
Area Code:
Zip Code:
Telephone:
CC: STATE OR FEDERAL LANDOWNER fif anv)
Agency:
Street:
City:
State:
Area Code: Telephone:
CC: STATE OR FEDERAL LANDOWNER (if anv)
Agency:
Street:
City:
State:
Area Code: Telephone:

Zip Code:
Zip Code: