1996-01-26_REVISION - M1978172

• Permit No: M1978172
• IBM Index Class Name: Revision
• Doc Date: 1/26/1996
• Doc Name: REGULAR OPERATION 112 RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: AM1
• Media Type: D
• Archive: No

-2- •
10. Correspondence Information:
AFIPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name: DONNA R. FERGANCHICK. DISTRICT #2 COMMISSIONER
Company Name: DELTA COUNTY
Street: DELTA COUNTY COURTHOUSE - 501 PALMER ST. . SUITE 227
Citv: DELTA
State: COLORADO Zip Code: 81416
Area Code: 970 Telephone: [phone]
PERMITTING CONTACT (i£ different from applicant/operator above)
Individual' s Name: CAROLYN S . CLEMENS
Company Name: DELTA COUNTY
Street: DELTA COUNTY COURTHOUSE - 501 PALMER ST. . SUITE 227
City: DELTA
State: COLORADO Zip Code: 81416
Area Code: 970 Telephone: [phone]
INSPECTION CONTACT
Individual's Name: JOHN TIMBREZA
Company Name: DELTA COUNTY
Street: DELTA COUNTY COURTHOUSE - 501 PALMER ST. , SUITE 227
City: DELTA
State: COLORADO Zip Code: 81416
Area Code: 970 Telephone:
CC: STATE OR FE)RRAL LANDOWNER (if aav)
Agency
Street:
City-
state: Zip Code:
Area Code: Telephone:
CC: STATE OP. FEDEP.AL LANDOWNER (if anv)
Agency:
Street:
City:
State: Zip Code:
Area Code: Telephone: