2004-07-23_REVISION - M1994096 ‎(2)‎

• Permit No: M1994096
• IBM Index Class Name: Revision
• Doc Date: 7/23/2004
• Doc Name: First Submittal of Appl
• From: High Plains Sand and Gravel LLC
• To: DMG
• Type & Sequence: CN1
• 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: Robert C. Pittincrton, Jr. Title: Manaver
Compa~Narme: High Plains Sand And Gravel, LLC

Street/P.O.Box: 12991 County Road 5 p.O.Box: P.O. Box 1227
City; Wellington

State: CO Zip Code: 8 0 5 4 9
Telephone Number: ( 9 7 0 1_ 5 6 8- 922 9

Fax Number: ( ~ -

PERMITTINGCONTACT (if different from applicanUoperator above)
Contact's Nsme: SAME Title:

Compaq Name:

Street/P.O. Box: P.O. Box:
City:
State:
Telephone Number:
Fax Number:
INSPECTION CONTACT
Contact's Name:
Compaq Name:
StreeUP.O. Box:
~Al'4~' Title:
Zip Code:
P.O. Box:
City:
State: Zip Code:
Telephone Number: ( 1-
Fax Number: ( 1-
CC: STATE OR FEDERAL LANDOWNER (if anvl
Agen<,y; NONE
Street:
City:
State: Zip Code:
Telephone Number: ( 1-
CC STATE OR FEDERAL LANDOWNER (if any]
Agency: ~IONR
Street:
City:
State:
Telephone Number:
Zip Code: