2005-05-12_REVISION - M2000018

• Permit No: M2000018
• IBM Index Class Name: Revision
• Doc Date: 5/12/2005
• Doc Name: Amendment Application
• From: Cheyenne County
• To: DMG
• Type & Sequence: AM1
• Media Type: D
• Archive: No

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6. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on pemilt)
Contact's Name: Marcy Brossman Title: County Administrator
Company Name: Cheyenne County
Street/P.O.Box: 51 S. 1st P.O.Box: 567
City; Cheyenne Wells
State: Colorado Zip Code: 80810
Telephone Number: (719 ? _ 767-5872
FaxNumbec (719 )- 767-5753
(if different from applicant/opemtorabcve)
Contact's Name:
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number:
Fax Number:
Same as above
INSPECTION CONTACT
Contact's Name:
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number
Fax Number:
P.O. Box:
Zip Code:
P.O. Box:
Zip Code:
CC: STATE OR FEDERAL LANDOWNER (if anvl
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( 1-
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( ) -
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