PERMFILE65930

• Permit No: M2007038
• IBM Index Class Name: Permit File
• Doc Date: 6/19/2007
• Doc Name: New Application
• From: Weld County
• To: DRMS
• Media Type: D
• Archive: No

•
-3-
i 1. Corresoondeoce Informatbn:
APPLICANT/OPERATOR (name, address, and phone of name to he used on permit)

Contact's Name: Titk: SBN/ r / Q
Company Name: ~+
C0uN7ti/ GlQC(C
W~LD /
GI~D,e%S
Street/P.O. Bm: D
• UO K / S ~ I ~~~
P ~ ~ S~,fOafP.O. Box:

Ciry: rr
IJ~~C ~~

state:
CO L
zip code: ~063Z
TelephoncNumber: 0
7
,_ 304- -
A
(
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/~
Fax Number: ~ p
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,~
~ ~
fL~- .3~¢ - (797
LL
C
.
-
PERMITTMO CONTACT (if different fran applicanUoperator above)
Contact's Name: S//. r'~-Q- Titk:

Company Name:

SvaUP.O. Box: P.O. Box:

City:

Stae: Zip Code:
Teephone Numbs ( 1-

Fax Number: (. 1-

INSPECTTONCONTACT
Contact's Name: S0. v`. a 7'itk:
Carnpanry Nmrc:
StreeUP.0. Box:
City:
State:
Telcp~hone Numlxr: ( i -
Fax Number: ( 1-
Agency:
Strew:
City:
State:
Telephone Number:
Agenry:
Street:
CiM1':
State:
Telephote Number:
P.0. Box:
Zip Code:
Zip Code:
Zip Codc:
•