REV106543

• Permit No: M1987103
• IBM Index Class Name: Revision
• Doc Date: 2/26/1992
• Doc Name: LIMITED IMPACT OPERATIONS 110 2 RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: AM1
• Media Type: D
• Archive: No

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9
Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name: u-rr.nRN:n STi;a~
Company Name: M. SIMS GRAVEL COMPANY
Street: P. 0. HOR 51 751 SOim'R VYFIITE AVENUE
City: RANGELY
State: rnr,cm-nn Zip Code: 81648
Ar~aa Code: 303 Telephone: 675^2306
PERMITT.[NG CONTACT (if different from applicant/operator above)
Individual's Name: SAME
Company Name:
Street:
City:
State:
Area Code:
INSPECTION CONTACT
Individual's Name
Company Name:
Str~aet:
Cite:
State:
Area Code:
Teiephone:
Zip Code:
Telephone:
Zip Code:
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency: armFen nr' r.enm ueuer.Ftim:nrm
Street: P. 0. BOX 928
City: MFFKFR
State: COLORADO Zio Code: 81641-0928
Area Code: ~0'~ Telephone: [phone]
CC: STATE OR FEDERAL LANDOWNER (if any)
Agen~;y: SAME
Street:
City
StdtE':
Area Code: Telephone:
Zip Code: