2005-07-21_REVISION - M1980027

• Permit No: M1980027
• IBM Index Class Name: Revision
• Doc Date: 7/21/2005
• Doc Name: Reclamation Permit Conversion Application Form
• From: DMG
• To: Bumgardner Ranches Inc
• Type & Sequence: CN1
• Media Type: D
• Archive: No

3-
11. Correspondence Information
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: 1 l ~ Title: _
Compa~Name: ~ f\C h
Streef/P.O. Box: Y~~~ ~ ~ DC P.O. Box:
City: V
State: n
l ~~ L~Q ~ ~~ Zip Cade: 0 tJ~i~ q
Telephone Number: n
1 ~S
(Q~~ ) - ~ ay "
Fax Number: n
(Q~~ 1- ~r-1y '1 ~ D3Z

PERMITTING CONTACT (if different from appl
canUoperatorabpve)
i
Contact's Name: /
~
~2~' C ~l l ' A Y' ~~:(- Title: ~Y'(' ~t ~'2f ~
Company Name: ~r 1 - ~~ V~

StreeUP.0. Box: 7 7 ~ ~-P ~~ P.O. Box: LR ~{
City: }~
YYl YY~ 1 l~ 1'l4
T \Y^~

State: 1
~~ l (~r~t n ~ ~ p~ ~ ~ ~y
Zip Code: (5 ~.r-l,~ `1
Telephone Number: n
n'
{ "1~Q ) - ~ a~ ^ "'l ~c~-`
Fax Number: ~ n -~01.~ q ~Q3 Z

INSPECTION CONTACT
Contact's Name: ~~~C C ~I ~ 0.V' ~ ~_Yl'~.r Title: P`f Cgt cL-l' YI,C
Company Name: ~~ i '- ~\J ~'
sr<eetm.o. Box: l
a-O ~ 1-P ~
` P.o. Box: ~ q ~
City: '~
~
~
-~~rn YYl ~ ~ Yt Q
State: ~~ ~[~Q~' ~ Zip Cade: C} ~ Sq
Telephone Number: n
(q-, ° , - ~~
~ "1
Fax Number: , t
~~ - ~c7- ~l ~ ~ ~ 7~

CC: STATE OR FEDERAL LANDOWNER (if ~1

Agcy:

Street:

City:

State: Zip Code:

Telephone Number: ( ) -

CC: STATE OR FIDERAL LANDO WNER (if anv)

Agency:

Street:

City:

State: Zip Code:

Telephone Number: ( 1-