2004-07-16_REVISION - M1994096

• Permit No: M1994096
• IBM Index Class Name: Revision
• Doc Date: 7/16/2004
• Doc Name: Fax of Conversion Material
• From: Randolph W. Starr P.C.
• To: DMG
• Type & Sequence: CN1
• Media Type: D
• Archive: No

-3-
14. Correaoondeoce Infor mation:
APPLICANT/OPERATOR (name, address; and phone of name to be used on permit)
Contact's Name: Robert C.' Pitting ton, Jr. Title: Manager_
CompanyNeme: High Plains Sand And Gravel, LLC
SIreeNP.O.Box: 12991 County Road 5 PO Box: P.O. Box 1227
C~,. Wellington
State: CO Zip Code: 8 0 5 4 9
Telephone Number: [ 9 7 0 t. 5 6 8- 9 2 2 9

Fax Number. ( t - '

PER MITTING CONTACT (if diffe:eot from app6ceat/operatornbove)
Contaet'sNeme: $AMF Title: -

Company Neme:

Street/P.O. Box: P.O. Box:

City.

State: Zip Code: -

Telephoae Number: ( t -

Fax Number: ( t -

INSP ECTLON CONTACT
Contact's N®e: S AMF Title:

Company Name:

Street/P.O. Box: P.O. Box: -

Ciry: '
.
State: Zip Code:

Telephone Number. ( t - -

Fax Number: ( t -

CC: STATE OR FIDERAL LANDOWNER [if aa~r
,4~~ NONE
Street: .

City:

State: Zip Code:

Telepbone Number: ( t -

CC• STATE OR FIDERAL LANDOWNER (if mtyl
Agenry: NONE

Street:

City:

State: Zip Code:

Telephone Number: (' 1-

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