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-3- <br />I10. Correepoadeace Znlormation: <br />APPLICANT/OPERATOR (name, address, and phone of name to be used on permit) <br />Individual's Name: ~fd'WL~S /q~12nCoLQ] <br />Company Name: ~~1-ln-tA-}~. /'i'jocs~dDF~clLt~'~L ~O~PR~Y __ <br />Street: P.O. Box: ~ 8 <br />city: r~.~+~P~,e~ <br />State: C.O Zip Code: G')~ ~~ <br />Area Code: ( .~03 ) Telephone: jLQ^3ZZj <br />PRRMITTINO CONTACT (if different from <br />individual's Name: F~~r/tnC4 <br />above) <br />////~ ~ 6 A ~ <br />Company Name : C,U ~ ~ ~~-' LS'7s D4~-! tl ~2 C:~`~-n.H'x-~}- <br />Stzeet: .- P.O. Box: (98' <br />City: ~Hti/~~/~C~ <br />State: C,o Zip Code: 8038 <br />Area Code: ( ~3 ) Telephone: 5~4~-32Z~ <br />INSPBCTIO~IP CONTACT <br />Individual' s Name : T wl ~`'/t(~ <br />Company Name : (~ ~ ,l u~t /~ #"K- !til a ~-Y'~>° y E.~.l~cc~ Goo ~/~~r <br />street: /CL~oZ (~u~17'4~ /Zb, ~ 3 P.O. Box: -~ <br />City: J~i~J2$ ~tL <br />State: C-~ Zip Code: _ ~O~lfl ~' <br />Azea Code: ( 3A3 ) Telephone: ~ (s9 -~ZZj <br />CC. STATE OR 88DBRAL LANDOWNER {if aay) /~(6~ <br />Agency: <br />Street; <br />City: <br />State: Zip Code: <br />Area Code: ( ) Telephone: <br />CCs STATE OR FEDERAL LANDOWNER (if anY) ~rxC <br />Agency: <br />Street: <br />City: <br />State: Zip Code: <br />Area Code: (__ )_ Telephone: <br />