REV14189

• Permit No: M1978011
• IBM Index Class Name: Revision
• Doc Name: REGULAR 112 PERMIT APPLCIATION FORM
• Type & Sequence: CN1
• Media Type: D
• Archive: No

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Correspondance Information:
APPLICANT/OPERATOR (name, address, and phone o[ same to be used on permit)
]ndividua!'s Name:
Company Name: Robinson Brick Comoenv.
Street: 1845 West Dartmouth
Clty: Denver.
State: Colorado. Zip Code: 80217.
Area Code: (303) . Telephone: 78 - 002.
PERMiTTiNG CONTACT (if different from applicant/operator above)
Individual's Name: Bradford Jenes.
Company Name:
Street:
City:
State:
Area Code:
INSPECTION CONTACT (it
Individual's Name:
Company Name:
Street:
City:
State:
Area Code:
Gambit. Inc
P.O. Box 5538.
Arvada
Colorado. Zip Code: 80005-0538.
(303) . Telephone: [phone].
different from applicant/operator above)
Michael G. Leidich
same
Zip Code:
Telephone:
1 1. Primazy future land use (check one):
^ Uopland (CR) ^ Pastureland (PL) ^ General Agriculture (GA)
X Rangeland (RL) ^ Forestry (FR) ^ Wildlife Habitat (WL)
^ Residential (RS) ^ Recreation (RC) ^ Industrial/Commercial (IC)
^ Developed Water Resources (WR) ^ Solid Waste Disposal (WD)
12. Primary present land use (check one):
^ Uopland (CR) ^ Pastureland (PL) ^ General Agriculture (GA)
X Rangeland (RL) ^ Forestry (FR) ^ Wildlife Habitat (WL)
^ Residential (RS) ^ Recreation (RC) ^ Industrial/Commercial (IC)
^ Developed Water Resources (WR) ^ Solid Waste Disposal (WD)
To the best of my knowledge, all of the information presented on this appplication Corm
and the attached Exhibits A-P aze true and correct (must be signed by
applicant/operator).
Date: 3 November .1989 By:
James C. Clark
Title: Vice President