REV94907

• Permit No: M1974004
• IBM Index Class Name: Revision
• Doc Date: 4/12/1991
• Doc Name: PERMIT FILE TABLE OF CONTENTS
• Type & Sequence: AM1
• Media Type: D
• Archive: No

,. :orresooneance infomation
'.PPLIC;,`JT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name:
Company Name: ~gohilP Premix "nnrrota. ?nr_ _
Stree*_: 1400 41. 64th Av .. PO Rax 7150111 _
City: Denver
State: CO Zip Code: ~n79t_;'125
Area Code: 304 Telephone: g7F_nnga _
PERMITTING CONTACT fif different from applicant/operator above)
Individual's Name: ,inhn r= H;rkman
Comoanv Name:
Stree*_:
City:
State:
Area Code:
Camp ac ahn~io
Telephone:
Zip Code:
INSPECTION CONTACT (if different from applicant/operator above)
Individual's Name: tnnn F u;rkman _
Company Name: Coma ac ahnva
Street:
Citv:
State:
Area Cade:
Zip Code:
Telephone:
11. Primary future Cropland(CR) Pastureland(PL) General AoricultureiGA)
land use - Ranaeland(RL) _
Forestry(FR) _
Wildlife HabitatlWL)
(check one): -_ Re sidential(RS) _
Recreation(RC) ~ Industrial/Cortenercial(IC)
Developed Water Resources(WR) Solid Wz~ste Disposal(WD)
12. Primary present Cropland(CR) Pastureland(PL) General Aariculture(GA)
land use _
Ranaeland(RL) _
Forestry(FRi _
Wildiifer Habitat(WL)
(check one): _
Re sidential(RSI - Recreation(RC1 ~ Industrial /Commercial(IC1
Developed Water Resources(WR)
"o the best of my knowledge, all the information presented on this application form and the
attacned Exhibits A-P are true and correct (must be si, ned by ap~l/icant'/ooer~itori.
late: • ~n,~~v - ~ ~ ~ 8Y: ~~P~.u~/
John F. Hickman, I•tgr•. Land &
s
it e