PERMFILE58563

• Permit No: M2005065
• IBM Index Class Name: Permit File
• Doc Date: 10/3/2005
• Doc Name: Completeness Response
• From: Charles R Ponchak
• To: DMG
• Media Type: D
• Archive: No

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6. Corxeutrondonce In fotmatMa:
APPLICANT/OPERATO R (name, address, end phone of name to be used on permit)
Contact's Name: „t, -~ d r _ Title: n n p r
Company Name:
StreetlP.O. Box: P.O. Box: : ~ ~
City: ~yj„1 i r } n n --
~~; Colorado Zip Code: 81.433
TelephoneNttmber: (970 1- ~A7 S2aa -
Fax Number: ( ) -
P~TTINO CONTAC T (if different from applicanUoperator above)
Contect'sName: Chartoa R, Ponchak _.____ TiNe:(~o oqi a Consultant
Comparry Name:
StrceUP.O. Box: i F 2 9 2 F 9 F n R rt P.O. Box:
City: Montrose
State: ~l n r a A n Zip COde: $1 4 (11
Telephone Number: ( 970 )- 249-2062 970-249-4434
Fax Number: ( 970 1- 2a.9-20ft)`
j~SPECTION CONTAC T
Contaa'sName: Jack Clark, Jr. Tiile: Owner
Company Name:
3treeUP.O. Box: P.O. Box:
City:
State: Zip Code:
Telephone Number: ( 1-
Fax Number:
CC• STATE OR FF
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Agency: ?,J~ ~
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Street:
City:
State:
Zip Code:
Telephone Numb~•:
CC• STATE OR FE RA ( t .
1 t A~rnC (if arwl
~Y
9trat:
City:
State: Zip Code:
Telephotrc Numbs: ( ) _