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-3- <br />+D. Correepoadeace Information: <br />APPLICANT/OPERATOR (name, addrre^s~, and phone of name to be used on permit) <br />Individual's Name: f-~~ -/• ~~~~F~ <br />Company Name: ~LI u-. +4}~ ~Llof-Y B afc Flu a-~ ~.K p/-{+-eY <br />Street: '- P.O. Box: ~ 8 <br />City: G~IkQ++2ti <br />State: ~ Zip Code: Cgo~{3 8 <br />Area Code: ( ~3 ) Telephone: Slob- 3z-Z,/ <br />PERMITTING CONTACT (if different from applicant/operator above) <br />individual's Name: ~~ !-f~'4'~ES <br />Company Name: ~CA+M~)~ tacc7~-Y'gDEtiLu"-~ (?orw/JgxtY <br />street: ~Cl~Z- C9u"tTf ~ ~3 P.o. Box: - <br />City: Pa-rLSt++~` <br />State: l..Q,) Zip Code: Bo~~S <br />Area Code: ( .30~ ) Telephone: ~(~-3ZZ( ~G'ZZ-v`f! <br />INSPECTION CONTACT <br />individual's Name: ~129i'['-f 120u-~-tG <br />company Name: Cf.Gd~+A-y L {uoc.Y5D4,~~+*~l L°alu--//A+e~ <br />Street: --- P.O. Box: 6 S <br />City : ~~cc~ t 2ti <br />State: CO Zip Code: ~~`E38 <br />Area Code: ( 3U ?j ) Telephone: S~`t^3ZZ1 y((zo~ <br />CCs 8TAT8 08 HSDERAL LA NDOWNER (iF es ty) <br />Agency: <br />Street: <br />City: <br />State: Zip Code: <br />Area Code: ( ) Telephone: <br />CCo STATE OR HEDERAL LANDOWNER (1E a ny) <br />Agency: <br />Street: <br />City: <br />State: Zip Code: <br />Area Code: ( ) Telephone: <br />