REV103198

• Permit No: M1990025
• IBM Index Class Name: Revision
• Doc Date: 9/11/1995
• Doc Name: REGULAR OPERATION 112 RECLAMATION FORM
• Type & Sequence: CN1
• Media Type: D
• Archive: No

-a-
10. Correspondence Information:
APPLICANT /OPHRATOR (name, address, and phone of name to be used on permit)
individual's Name: WILLIAM K. GOODE
Company Name: BLASTING AND MINING, INC.
street: P.O. BOX 656 (7452 C.R. 24B)
City: CORTEZ
State: COLORADO zip Code: 81321
Area Code: (970) Telephone: [phone]
PHRMITTING CONTACT (if different from applicant/operatoi above)
individual's Name: SAME
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
INSPHCTION CONTACT
Individual's Name: SAME
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
- 19 No. 074
E RECEIPT ate ~
e Received From
A Address ~•
For
a
m~ ACCOUNT HOW PAID
SI AMT. OF CASH a
ZpSS ACCOUNT
AMi. AA~D C
gAiANCE MONEY BY
OUE OADEP
Zip Code:
Area Code: Telephone: