2005-01-31_REVISION - M1979163

• Permit No: M1979163
• IBM Index Class Name: Revision
• Doc Date: 1/31/2005
• Doc Name: Amend as TR 110c Amend Appl
• From: Las Animas County
• To: DMG
• Type & Sequence: AM2
• Media Type: D
• Archive: No

Qw
-3-
14. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: Phil DorenkamP Title: R & B SupV.
Company Name: Las Animas County
Street/P.O.Box: 2000 N Linden Ave P.O.Box:
City: Trinidad
State: Colorado Zip Code: 81082
Telephone Number: F 7 7 9 )- 8 4 6 2 9 31
Fax Number: ! 719 )- R4fi f14't4
PERMITTING CONTACT (if different from applicantloperator above)
Contact's Name: carno
Company Name:
StreetlP.O. Box:
City:
State:
Telephone Number:
Fax Number:
INSPECTION CONTACT
Contact's Name:
Company Name
StreeUP.O. Box:
City:
State:
Telephone Number: ( ) -
FaxNumber: ( )-
CC STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
Ciry:
State:
P.O. Box:
Zip Code:
P.O. Box:
Zip Code:
Zip Code:
Telephone Number: ( ) -
CC• STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
Ciry:
State:
Telephone Number: ( )
Zip Code: