REV89482

• Permit No: M1978210
• IBM Index Class Name: Revision
• Doc Date: 7/8/1998
• Doc Name: CONSTRUCTION MATERIALS REGULAR 112 OPERATION RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: AM3
• Media Type: D
• Archive: No

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CorroeDOadenca Iaformation:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: f:rAg Nolenn Title: Supervisor
Company Name:
Street:
City:
State:
Telephone Number
Fax Number:
PERMITTING CONTACT
Contact's Name
Company Name:
Street:
Weld County Mining Division
P. 0. Box 11758
Greeley
Colorado Zip Code: 80632
( 970 ) - 356-4000 Ext. 3750
( 970 ) - 352-2868
(if different from applicant/operator above)
Donald Carroll Title: EnAineerin¢, Admin.
City:
State:
Telephone Number:
Fax Number:
INSPECTION CONTACT
Weld County Public Works
P. 0. Box 11758
Greeley
Colorado Zip Code: 80632
( 970 ) - 356-4000 Ext. 3750
( 970 ) - 352-2868
Contact's Name: Greg Nelson Title: Supervisor
Company Name: Wald .o +n y Mining Division
Street: P. O. Rnx Jl75R
City: Greeley
State: Colorado Zip Code: 80632
Telephone Number: ( 970 ) - 356-4000 Ext. 3750
Fax Number: ( 970 ) - 352-2868
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency: N/A
Street:
City:
State:
Zip Code:
Telephone Number: ( ) - _
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency: N/n
Street:
City:
State;
Zip Code:
Telephone Number: