2004-04-27_REVISION - M2000053

• Permit No: M2000053
• IBM Index Class Name: Revision
• Doc Date: 4/27/2004
• Doc Name: Conversion Application
• From: Las Animas County
• To: DMG
• Type & Sequence: CN1
• Media Type: D
• Archive: No

~ .~ ,
-3-
14. Correaooodence 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: ('~lorado Zip Code: A1052
Telephone Number: ( 71 9 ) - 8 4 6 - 2 9 31
Fax Number: ( 719 )- 846-0434
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: same as above Title:
Compamy Name:
Street/P.O. Box: P.O. Box:
City:
State:
Teleph~e Number:
Fax Ntmtber:
INSPECTION CONTACT
Contact's Nerve:
Compmry Nerve:
Strcet/P.O. Box:
City:
State:
Zip Code:
same as above
Title:
Telephone Number: ( ) - -
Fax Number: ( ) - -
CC STATE OR FEDERAL LANDOWNER (d anv)
Agency:
Street:
City:
State:
Telephone Number: ( ) - _
CC STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City: ,
Sate:
Telephone Number: ( ) - -
P.O. Box:
Zip Code:
Code:
Zip Code: