2004-12-06_REVISION - M1977472

• Permit No: M1977472
• IBM Index Class Name: Revision
• Doc Date: 12/6/2004
• Doc Name: Conversion Appl
• From: Jackson County
• To: DMG
• Type & Sequence: CN1
• Media Type: D
• Archive: No

3-
14. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: Nelson Selcer Title: Supervisor
Company Name: JxJcvt Car4~Road and &id~

Street/P.O. Box: l88 Grant Street P.O. Box 488
City: Waklat

State: Colorado Zip Code: 80480

Telephone Number. ( 970 )- 723-4481

Fax Number: ( 970 1- 723 S~F37

PERMITTING CONTACT (if different from applicanUoperatorabpve)
Contact's Name: Title:

Company Name:

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

City:

State: Zip Code:

Telephone Number. ( 1-

FaxNumber: { ) -

INSPECTION CONTACT
Contact's Name: John Motrone Title:

Company Name: BtueatofL~dMu~na>r

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

City: IGatvnlatg

State: Colorado Zip Code:

Telephone Number. ( 1-

FaxNumber: ( Z-

CC: STATE OR FEDERAL LANDOWNER (if anyl
Agency: Btnr~t ofl~d M~~ttan

Street: 2103 Fast Pmic Averx~e P O Bo:c 68
City: 1C~atunlug
State: Colorado
Telephone Number: ( 970 1 -72434
CC: STATE OR FEDERAL LANDOWNER (if anvl
Agency:
Street:
City:
State:
Telephone Number: ( )-
Zip Code:
Code: