2006-09-21_REVISION - M1980149

• Permit No: M1980149
• IBM Index Class Name: Revision
• Doc Date: 9/21/2006
• Doc Name: 112c application
• From: Weld County
• To: DRMS
• Type & Sequence: AM3
• Media Type: D
• Archive: No

-3-
1I. Corresaondence Information:
APPLICANT/OPERr1TOR (name, address, and phone of name to be used on permit)
Contact's Name: Greg_Nelson Title: _
Company Name: Weld County
StreeUl'.O. Box: P.O. Box: 758
City: Greeley
State: _Colorado Zip Cade: 80632
Telephone Number: L970 )- 356-4000 x3776

Fax Number: L ) -
PERIvlITTING CONTACT (if different from applicanUoperator above)
Contact's Name: Jennifer Lee Title: En eineer
Company Name: Applegate Group, Inc.
StrecUP.O. Box: 1499 W. 120th Avenue. Suite 200 P.O. Box:

City: Denver
State: Colorado Lip Code: 80234
TelephoneNtmtber: (303 )- 452-6611

Pax Number: (903 )-__~,~2-2754
INSPECTION CONTACT
Contact's Name: Same as Operator Title:

Company Name:

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

State: Z.ip Code: _
Telephone Number. ( ) - _____
Fax Number: L J -
CC: STATE OA FEllERAL LANDOWNL•R (if any)
Agency: _
Street:
City: ____
State: ____ _
Telephone Number: ( ) - ~,
CO STA"fF OR FEDERAL I ANDOWNPR (i~any)
Agency:
Street:
City: __~
State:
Zip Cade:
'Lip Code:
Telephone Number: ( _~ -