REV11497

• Permit No: M1990047
• IBM Index Class Name: Revision
• Doc Date: 10/16/2003
• Doc Name: Application
• From: Fremont County
• To: DMG
• Type & Sequence: AM1
• Media Type: D
• Archive: No

-3-
14.
Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: ~~ ma C(1 ~'(~ G,,r.~ Title: ~'o ~ttT~Q m 2+1~ S'~~ o W ~Q
Company Name:
Street:
~ 00
City: CArvorJ (~TVT
State: ~o w R.YtDO Zip Code: $12a Z
Telephone Number: ( ~1% 1- ?.~(o - ~~O
Fax Number: ( ~~ 9 1- 23'5' ~ b 2l0
PERMITTING CONTACT (if different from applicanUopera[or above)
ContactsNmme: Y-~i~NitTH S. ~m Tifle:~vonlS. Gc~w~l~t
Company Name: ~V,Q..tT~c.. --iNG.
Street: P ~ , gr1~t 3.3 A
City: CarooaX 1
State> CO to R.Ltipo Zip Code: a 2 223
Telephone Number: ( ~ ~ ~i 1- 94 Z' ~-1'~C~
Fax Nmnber: ( ~1 ~' 1- °J4 Z- 41 ~ ~
INSPECTION CONTACT
Contacts Nmme:
Compaq Nmme:
Street:
City:
State:
Telephone Number
Fax Number:
~aub- ~A224:"'IT Title: C-0~h(~Sv,c~l~Y1Sa2,
-Y-2EM O r~l -r ~©v r\1T~ Y-o RO 9t 2~b(~~~ 11EQ'T
CC: FEDERALLANDOWNER(ifanyl n
agency: tTiSR,I-.C-~1 Ntt+EC~-c~oty+ Qom} Mr35~~>_;cor`.
Street: '31,"1-D ~A~r ~R1sv ~YL~E:t
City: tngivaSCn-W
Stale: ~owtt,o~pp Zip Code: ~~2~Z
Telephone Number: ( 3~ ~ 1 • 2(0 9 - Q~SOO
CC STATE OR FEDERAL LANDOWNER (if anvl
Agency:
Street:
City:
State:
Telephone Number: ( 1 -
Zip Code:
t ~d LO QR~~ Zip Code: ~ty'Z_.
( ~1~ )- 'L~-l,• 3=120 oQ- 31oJ-~J4Z-42T~d-
L~l~ ~- 2'3~' x/0210