REV106535

• Permit No: M1991073
• IBM Index Class Name: Revision
• Doc Date: 6/16/1992
• Doc Name: LIMITED IMPACT OPERATION 110 2 RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: CN1
• Media Type: D
• Archive: No

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9. Correspondence Information:
APPLIC/U1T/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name:
Company Name: xiowA covMrx, COLORADO
Street: P.O. BOX 591
C 1'Cy : EARS
State: coLORADO Zip Code: stn~F
Area Code: 719 Telephone: [phone]
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name: SAME
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
INSPECTION CONTACT
Individual's Name: sAME
Company Name:
Street:
City:
State: Zip Code:
Area Code: ~ Telephone:
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency: *~ie - -- --- --
Street:
City:
State: Zip Code:
Area Code: Telephone:
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency: Nin
Street:
City:
State: Zip Code:
Area Code: Telephone: