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-3- <br />11. Correaoondence Wormatbn: <br />APPLICANT/OPERATOR (name, address, and phone of name to be used on permit) <br />Contact's Neme: Tnle: <br />COmpatryName: K' a !' nt3t., f'nlnr A <br />Street/P.O.Box: 1'305 -Goff Street P.O.Box: 100 <br />City: Eads <br />State: CO Zip Cie: 81036 <br />Telephone Number: { 719 )- 438-5810 <br />Fax Number: ( 719 )- 438-5327 <br />PERMITTING CONTACT (if different from applicanUopemtoraboye) <br />Contact's Name: Debra Immer, Rodney Hopkins Title: Administrator, Road Supv <br />Company Name: Kiowa County Colorado <br />S1reeUP.O. Box: Sa a ahnva P.O. Box: <br />City: <br />State: Zip Code: <br />Telephone Number: ( 1- <br />Fax Number: ( 1- <br />INSPEC'fION CONTACT <br />Contect'sName: Rod Brown Rodney Hopkins Title: Cornmissioner, Road Supv <br />CompatryName: ----a fnunf~ C^t^Y~ao <br />StreetlP.O. Box: Same as above P.O. Box: <br />City: <br />State: ~P Co~~ <br />Telephone Number: ( 1 - <br />Fax Number: ( 1- <br />CC STATE OR FEDERAL LANDO WNER (if aml <br />Agency: <br />Street: <br />City: <br />Stele: Zip Code: <br />Telephone Number: ( ) - <br />CC STATE OR F ~DERA L LANDOWNER (if aml <br />Agency: <br />Street: <br />City: <br />State: Zip Code: <br />Telephone Number: ( 1 - <br />