REV96310

• Permit No: M1974086
• IBM Index Class Name: Revision
• Doc Date: 8/26/1994
• Doc Name: REGULAR OPERATION 112 RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: AM2
• Media Type: D
• Archive: No

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9. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name: Robert Biseard
Company Name: Asphalt Paving Company
Street: 14802 West 44th AVenue
City: Golden,
State: C~ Zip Code: 80403
Area Code: 305 Telephone: [phone]
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name: Same as above
Company Name:
Street:
City:
State:
Area Code:
INSPECTION CONTACT
Individual's Name
Company Name:
Street:
City:
State:
Area Code:
Zip Code:
Telephone:
Same as above
Zip Code:
Telephone:
CC: STATE OR FEDERAL LANDOWNER (if anv)
Agency: - None
Street:
City:
State: Zip Code:
Area Code: Teiephone:
CC: STATE OR FEDERAL LANDOWNER (if an
Agency: None
Street:
City:
State:
Zip Code:
Area Code: Teiephone: