2003-05-02_REVISION - M1983106

• Permit No: M1983106
• IBM Index Class Name: REVISION
• Doc Date: 5/2/2003
• Doc Name: Amendment Application
• From: Cheyenne County
• To: DMG
• Type & Sequence: AM1
• Media Type: D
• Archive: No

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14. Corrpnondence Information:
APPLICANTIOPERATOR (name, address, and pho~ of name to be used on permit)
ContacYsName: Lara Crowell Titre: County Administrator
Compa~Name: Cheyenne County
Street/P.O.Box: P.0. Box 567 P.O.Box:
City: Cheyenne Wells
State: CO Zap Code: 80810
Telephone Number: (719 ~_ 767-5872
Fax Number: ( 719 l_ 767-5753
PERMITTING CONTACT (if different Jiam applicam/operator above)

Contacts Name:
Company Name:
StreeUP.O. Box:
City:
State:
Telephone N>ffiber.
Fax Number:
Contact's Name:
Compaq Name:
Street/P.O. Box:
City: Cheyenne Wells
State: CO Zap Code: 80810
TetephoneNumber: ( 719 )_ X62-3270
Fax Number: ( 719 1- 767-5753
CC: STATEURFEDERAI.LANDOWNER(ifany]
Agemy:
Street
City:
State:
Code:
Carl Randel
P.O. Box:
Tifle: Foreman
Chey enne County Road and Bridge
P.0. Box 567 P.O.Box:

Telephone Number: ( ) --
CC: STATE OR FIDERAL LANDO9UNER (if mmv~
Agency:
Streer:
City:
Siate:
Telephone Number.
Zip Cade:
Zip Code: