2007-03-06_REVISION - M1998071

• Permit No: M1998071
• IBM Index Class Name: Revision
• Doc Date: 3/6/2007
• Doc Name: Conv Appl
• From: Richard Fryrear
• To: DRMS
• Type & Sequence: CN1
• Media Type: D
• Archive: No

3-
l t. Corresoondeoce Information:
APPh{CANT/OPERATOR (name, address, and phone of name to be used on pemtit)
Contact's Narne: Richard Fryrear Title; Owner
Company Name:
StreetlP.O. Box: • 08085 Go. Rd. 13 P.O. Box:
City: Haxtnn
State: CO Zip Code: 80731
TetephoneNumber: ( 970 1- 774-6551

Fax Number: L ) -
PERM[TTING CONTACT (if different from applicant/operator above)
Contacts Name: gan A~ R h~afar Title:Cnnaul an
Company Natne:

Streef/P.O. Box: 4n5RFi Cn- Rd _ 71 P.O. Box:
City: Haxtnn
State: CO 'Lip Code: 80731
Telephone Number, ( 97(1 1-R54-477R (work) 970-77 -62 64 (home) 970-520-0502 (cell)

Pax Number: ( g7Il 1-$-5f~_4R11
INSPECTION CONTACT
Contact's Name: Richara F+-yrrar ~ Tide:_prmer _
Company Name:

StreetlP.O. Box: pgpRS ('., _ Rd _ 19 P.O. Box:
City: ~ Haxtim

State: CO Zip Code: 807 31 _
Telephone Number: ( 97p 1- 774-(,55}

Fax Number. ( 1-
CC: STA'PF. OR FEDERAL LANDOWNER (sF anvl
Agency:

Street:
City: ____ -__-,~

State: _ ____! , Zip Code: ,_ _,
Telephone Number: ( ) -, _
__
CC'' STATF, OR FEDERAL L,ANL30WNER /if anvl
Agency:

Street:
City: ---
-
- ------
State: __ ______ lip Code: ,~__ J~._.__
"Telephone Number. ( 1- ___ _.~_____ _ __