2006-03-15_REVISION - M1991074

• Permit No: M1991074
• IBM Index Class Name: Revision
• Doc Date: 3/15/2006
• Doc Name: 112 Application
• From: Kiowa County
• To: DMG
• Type & Sequence: AM1
• Media Type: D
• Archive: No

s
-3-
11. Correaooedeece Informatbe:
APPLICANT/OPERATOR (name, address, end phone of nattte to be used on petati[)
Contact's Name: Title:
CompatryName: Kinca rnnnr3t., rnlnraAn
Street/P.O.Box: 1'305 Goff Street p,p,Bax; 100
City: Eads
Smote; CO yip Cam; 81036
Telephone Number: ( 719 )- 438-5810
Fax Number: ( 719 )- 438-5327
PERMITTING CONTACT (if different from applicent/opemtor above)
Contact's Name: Debra Immer, Rodney Hopkins Title: Administrator, Road Supv
CompatryName: Kiowa County, Colorado
Street/P.O. Box: Sama a c al,nve P.O. Box:
City:
State: Zip Code:
Telephonre Number: ( 1-
Fax Number: ( ) -
INSPECTIONCONTACT
Contect'sNeme: Rod Brown, Rodney Hopkins Title: Commissioner, Road Supv
Company Name: Ki nwa ('nnnryr Cnl nradn
Street/P.O. Box: Same as above P.O. Box:
City:
State: Zip Code:
Telephone Number: ( 1-
Fax Number: ( 1-
CC: STATE OR FEDERAL LANDOWNER (if any,)
Agency:
Street:
City:
State: Zip Cade:
Telephone Number: I ) -
CC: STATE OR FEDERAL LANDOWNER (if atly~
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( ) -