REV13231

• Permit No: M1980239
• IBM Index Class Name: Revision
• Doc Date: 10/18/2000
• Doc Name: REGULAR 112 OPERATION RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: AM1
• Media Type: D
• Archive: No

.~

-s-
14. Cotteaoondeecelnfotmatioe:
APPLICANT/OPERATOR (name. address, and phone of name to be used on permit)
Contact's Name: Dennis r;. Jones
company Name: 6:offat County Road Department
Title: Road supervisor
Street: F.O. Box 667
cin~: Craig
State: CO Zip Code: 81626
Telephone Number: ( 970 ~_ 824-3211

Fax Number: j 1 -

PERMITTINGCONTACT (if d~'erent from applicant/operator above)
Contact's Name: 6SarVln flioore Title;Consultant
Company Name: N~A
Street: 1570 Ranney St.
C;,y: Craig
Sute: Colo. Zip Code: 81625
TelephoneNamber. f970 ~- 824-9249

Fax Number: ( 1-
INSPECTION CONTACT
Contact'sNmme: Either Above
Company Name:
Street:
Ciry:
State:
Telephone Ntnnber: ( 1-
Fax Number: ( 1-
CC: STATE OR FED RAi L WNER (if anvl
Agency: N~A
Stteet:
Ci[v
State:
Telephone Number: L 1- _
C_ C: STATE OR FEDERAL LANDONNER (if any
Agency. NCH
Street:
City:
State:
Telephone Number:
Zip Code:
Zip Code:
Zip Code: