REV104791

• Permit No: M1999069
• IBM Index Class Name: Revision
• Doc Date: 9/19/2005
• Doc Name: Construction Materials Regular ‎(112)‎ Operation Reclamation Permit Application Form
• From: Jake Kauffman & Son Inc.
• To: DMG
• Type & Sequence: AM1
• Media Type: D
• Archive: No

3-
11. Correaooadence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: Frank Kauffman Title: President
Compa~ryName: Jake Kauffman & Son, Inc.
Street/P.O. Box: 808 South County Road 9E P.O. Box:
City: Loveland
State: Colorado Zip Code: 80537
Telephone Number: { 970 1- 667-1557
Fax Number: f 970 1- 667-9985
OTTING CONTACT (if different from applicant/operator above)
Contact's Name: William S chenderlein Title: Prof rr .nginear
Company Name: Apple Rate Group, Inc.
5treet/P.O.Box: 1499 West 120th Avenue, Suite 200 P.O.Box:
City: Denver

State: Colorado Zip Code: 80234
Telephone Number: (903 1- 452-6611

Fax Number: (303 )- 452-2759
Contect'sName: Frank Kauffman Title: President
CompanyNeme: Sake Kauffman & Son, Inc.
StreetlP.O. Box: 808 South County Road 9E P.O. Box:
City: Loveland
State: Colorado Zip Code: 80537
Telephone Number:
Fax Number:
CC: STATE OR FEDERAL (970 1- 66;
(970 1. 66;
LANDOWNER (if arty]
Agency:
Street:
City:
State:
Telephone Number: ( ) - _
CC: STATE OR FEDERAL LANDOWNER (if soul
Agency:
Street:
Citc:
State:
Telephone Number: ( ) -
Code:
Zip Code: