2003-09-10_REVISION - M2001060

• Permit No: M2001060
• IBM Index Class Name: Revision
• Doc Date: 9/10/2003
• Doc Name: Conversion Application
• From: 3B Enterprises LLC
• To: DMG
• Type & Sequence: CN1
• Media Type: D
• Archive: No

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14. Correanondence Information:
APPLICANTlOPERATOR (name, address, and pho~ of name to be used on permit)
ConiacPs Name: S7>=(,(E g At kC^YZ Title: © W t~1'c`YL_
Compaq Name: 3 ~ C N i~c-YZP FLi- Sc5 ~ ~-~.-~-
StrceUP.O. Box: 12o O C ~ S~ ~ (TL~'~ P.O. Box: Ilo(o~
cuy: G ~A ~~
state: CO zip code: Sc I ~ ZS /6 ~ Ar.
Telephone Number: (~ ~y ) - $Z 4 - 0 2 2s
Fax Number: ( ~~V ~ - 8 Z4 - 3 8"l 2-

PERMITTING CONTACT (if different from applicanUoperator above)
Contact's Name: ~ff'N?r .N-S f{ !i U /C Title:

Company Name:

StreeUP.O. Box: P.O. Box:

City:

State: Zip Code:
Telephone Number: ( 1-
Fax Number: ( 1-
ContacCs Name:
Company Name:
SttceUP.O. Box:
City:
State:
~A-~+t E fh5 ft' ~v/ c
P.O. Box:
Code:
Telephone Number: ( 1-
Fax Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER (if anv)
Agency: f~i'~ F
Street:
Citv:
State:
Telephone Number: ( 1-
CC: STATE OR FEDERAL LANDOW'NF.R (if anvl
Agency: Il/0l~F
Street:
City:
State:
Telephone Number.
Zip Code:
Zip Code: