REV92538

• Permit No: M1978357
• IBM Index Class Name: Revision
• Doc Date: 6/12/1998
• Doc Name: CONSTRUCTION MATERIALS REGULAR 112 OPERATION RECLAMTION PERMIT APPLICATION FORM
• Type & Sequence: CN1
• Media Type: D
• Archive: No

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corresDOadenc~ Informatioa:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: Edward J. Settle Title:
Company Name: (:rand .1 ~n ion P~pr+ &yRply Co.
Street: P.O. Sox 1$49
City: Grand Junction
State: Colorado Zip Code: 81502
Telephone Number: ( 970 ) - 243-4604
Fax Number: ( 970 ) - 243-6703
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: Title:
Company Name:
Street:
City:
State:
Telephone Number:
Fax Number:
INSPECTION CONTACT
Contact's Name
Company Name:
Street:
City:
State:
Zip Code:
Same ac above Title
Zip Code:
Telephone Number: ( ) - _
Fax Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER (if anv)
Agency:
Street:
City:
State:
Telephone Number: j ) - _
CC: STATE OR FEDERAL LANDOWNER (if anv)
Agency:
Street:
City:
State:
Zip Code:
Zip Code:
Telephone Number: