REV16074

• Permit No: M1988048
• IBM Index Class Name: Revision
• Doc Date: 2/29/2000
• Doc Name: CONSTRUCTION MATERIALS REGULAR 112 OPERATION RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: AM1
• Media Type: D
• Archive: No

• -~-
14. C~rteaoondeece Intormatioe:
APPLICANT/OPERATOR (Dame, address, and phone of name to be used on permit)
Contact's Name: ' R; ~k Fvar; cr
- Title: Vice--President
Company Name: Andesite Rock Compan
Sweet: 7321 E. SSth Ave. , Suite 200
CttY: Henderson
State: Colorado
Telephone Number ( 303 )_ 287-4656
Fax Number: ( 303 )_ 287-8076
PERMITTING CONTACT (if di8'erent from applicanUoperator above)
ContacYsName:~T Rob Laird
Company Name: Banks and Gesso, LLC
Street: 720 Kiplin>; St., Suite 117
Citr~: Lakewood
State: -Colorado Zip Code: 80215

TelephoneNmnber ( 303 )- 274-4277
Fax Number: ( 303 )_ 274-8329
INSPECTION CONTACT ~(-

ContacYsName: Rick Everist Tie; Vice~President
Company Name: Andesite Rock Company
Street: 7321 E. 88th Ave., Suite 200
City: Henderson,
State: Colorado Zip Code: 80640

Telephone Number: ( 303 )_ 287-4656
Fax Number: ( 303 )- 287-8076
CC STATE OR ~'DERA T i R ff anv)
Agency: n / a
Street:
City:
State: Zip Code:

Telephone Number: ( t _
CC STATE OR FEDERA L LANDOWNER (if any]

Agency: n/a
Street:
City:
Smote: Zip Code:

Telephone Number: ( ) _
Zip Code: 80640