REV104937

• Permit No: M1978107
• IBM Index Class Name: Revision
• Doc Date: 7/6/1998
• Doc Name: CONSTRUCTION MATERIALS REGULAR OPERATION 112 RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: AM2
• Media Type: D
• Archive: No

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14. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: Title•
Company Name: MONTEZUMA COUNTY
street: 109 WEST MAIN ST., ROOM 302
city: CORTEZ
state: CO zip code: 81321
Telephone xumber: ( 970 ~ - 565-8317

Fax Number: ( ~ ) -

PERHITTING CONTACT (if different from applicant/operator above)
Contact's Name: BRIAN KIMMEL Title: PRESTDRNT
company Name: SOUTHWEST LAND SERVICES, INC.
street: P.0. BOX 2673
City: DURANGO
state: CO zip Code: 81302
Telephone Number: 1 970 ~ _ 259-2629
Fax Number: 1 970 ~ - 259-0181
INSPECTION CONTACT
Contact's Name: TOM WEAVER Title: COUNTY MANAGER
Company Name: MONTEZiIMA COIiNTY ,
street: 109 WEST MAIN ST., ROOM 302
city: CORTEZ
state: CO z1p code: 81321
Telephone Number: ( 970 ~ _ 565-8317

Fax Number: 1 ) -

CC: STATE OR FEDERAL LANDOWNER (if anvl
Agency: BUREAU OF LAND MANAGEMENT
Street: 701 CAMINO DEL RIO
city: DURANGO

state: CO zip code: 81301
Telephone Number• 1 970 ~ _ 247-4082
CC: STATE OR FEDERAL LANDOWNER (if soul
Agency:
Street:
City:
State:
zip Code:
Telephone Number: