HYDRO30066

• Permit No: C1989074
• IBM Index Class Name: Hydrology
• Doc Date: 12/28/1994
• Doc Name: YOUR REQUEST FOR INACTIVATION for Permit NO. COG-850030
• From: COLO DEPT OF PUBLIC HEALTH & ENVIRONMENT
• To: LANDMMARK RECLAMATION INC
• Permit Index Doc Type: NPDES
• Media Type: D
• Archive: No

STATE OF COLORADO
COLORADO DEPARTMENT OF HEALTH
Dedicated to protecting and improvingg the health and
environment o(the people o(Colorado
4300 Cherry Creek Dr. 5. Laboratory Building
Denver, Colorado 00222-1530 4210 E. 11th Avenue
Phone [phone] Denver Colorado 80220-3716
RECEIVED ~~of ~~~
DEC 2 8 1994 ~`
..
• M
~ re 76 ~
Division of Minerals is Geology
[phone] Ray Ramer
Cne+nor
APPLICATION FOR TRANSFER AND ACCEPTANCE OF TERMS paVioaA Nolan, MD, MPH
OF A COLORADO PERMIT ~~""'eafe°°r
I hereby apply
Number COe~i=$
issued to ~c
I have reviewe
and liability,
NEW OWNER:
fora transfer of ownership of this Colorado Permit,
5vo3~ in .Cove n,~.:m.~~J county, which was
Project or Facility Name:
Mailing Address:
City:
County:
Authorized Agent:
State:
Zip:
Telephone No:
area code
please print
Signature:
Title:
Facility Contact _
(if other than owner)
Facility Address:
Telephone No:
area code
As previous owner, I hereby agree to the transfer of the above-
referenced permit and all responsibilities thereof.
PREVIOUS OWNER/OPERATOR
Facility Name:
Authorized Agent:
please print
Signature:
Date:
Title
Current Telephone No: ( 1 Date: