REV07400

• Permit No: M1981277
• IBM Index Class Name: Revision
• Doc Date: 7/22/1994
• Doc Name: LIMITED IMPACT OPERATION 110 2 RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: AM1
• Media Type: D
• Archive: No

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9. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name: Leonard 6 Michael Loukonen
Company Name: Loukonen Bros: Stone
Street: P.O. Box 333
City: Lvons
State: Colorado Zip Code: 80540
Area Code: (303) Telephone: [phone]
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
State:
Area Code:
INSPECTION CONTACT
Individual's Name
Company Name:
Street:
City:
State:
Area Code:
Zip Code:
Telephone:
Michael or Leonard Loukonen
Loukonen Bros. Stone
F,. O. Box 333
Cnlnradn Zlp Code:
Telephone:
CC: STATE OR FEDERAL LANDOWNER (if anv)
Agency:
Street:
City:
State:
Area Code:
Telephone:
CC: STATE OR FEDERAL LANDOWNER (if an
Agency:
Street:
City:
State:
Area Code: Telephone:
Zip Code:
Zip Code: