_REVISION - M1977451 ‎(7)‎

• Permit No: M1977451
• IBM Index Class Name: Revision
• Doc Name: REGULAR 112 PERMIT APPLICATION FORM
• Type & Sequence: CN1
• Media Type: D
• Archive: No

-2-
• 10. Correspondance Information
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Individual ' s Name: J. P. McCluskey
Company Name: Cotter Corporation
Street: 12596 W. Bayaud Avenue, Suite 350
City: Lakewood
State: CO Zip Code: 80223
Area Code: 303 Telephone: [phone]
PERMITTING CONTACT (if different from applicant/operator above)
Individual ' s Name: W. 0. Hester
Company Name: Cotter Corporation
Street: P.O. Box 700 (28151 DO Road)
City: Nucla /
State: CO Zip C de: 81424
Area Code: 303 Telephone: [phone]
I14SPECTION CONTACT (if different from applicant or above)
Individual 's Name: W. D. Hester
• Company Name: Cotter Corporation
Street: P.O. Box 700 (23151 DO Road)
City: Nucla
State: CO Zip Code: 81424
Area Code: 303 Telephone: [phone]
11 . Primary future Cropland(CR) _ Pastureland(PL) General Aariculture(GA)
land use X Rangeland(RL) _ Forestry(FR) — Wildlife Habitat(WL)
(check one) : —_ Residential (RS) Recreation(RC) — Industrial /Commercial ( IC
Developed Water Resources(WR) — Solid Waste Disposal (Wo '
12. Primary present Cropland(CR) Pastureland(PL) General Aariculture(GA)
land use X Rangeland(RL) — Forestry(FR) — Wildlife Habitat(WL)
(check one) : — Residential (RS) Recreation(RC) — Industrial /Commercial ( IC
Developed Water Resources(WR)
To the best of my knowledge, all the information presented on this application form and the
attached Exhibits A-P are true and correct (must be sinned by applica /operator).
Date: ����f By:
0
Title