2004-06-30_PERMIT FILE - M2004048

• Permit No: M2004048
• IBM Index Class Name: Permit File
• Doc Date: 6/30/2004
• Doc Name: Application
• From: Robert Daugherty
• To: DMG
• Media Type: D
• Archive: No

-3-
14. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit}
ContacfsName: Rnhar+ na„ghart,~ _ Title: Individual
Company Name:
City: Clifton
grate; Colorado Zip Code: 81520
Telephone Number: ( 970 )- 434-8773
Fax Number: ( 970 )- 242-R43R
PERMITTING CONTACT (if different from applicant/operator above)
Contacts Name: G e r a l d ,T _ n a n b Title: P r e s i d e n t
Company Name: Daub & Associates. Inc.
Street/P.O.Box: 1985 1/2 South Br~adwav P.O.Box:
Cny; Grand Jun
State: Colorado Zip Code: 81503
Telephone Number: ( 970 )- 254-1224
Fax Number: [ 970 ~- 242-
INSPECTION CONTACT
Contact's Name: Robert Daugherty Ti@e: Individual
Company Name: N/A
Street/P.O. Box: P.O. Box:
City:
State:
Clifton
Colorado Zip Code: 81520
Telephone Number: ( 970 )- 434-8773
Fax Number: j 970 )- 242-8438
CC: STATE OR FEDERAL LANDOWNER (if any}
Agency: U.S. D.O.I. BLM San Juan Public Lands Center
Street: 15 Burnett Court
City: Durango
State: Colorado Zip Code: 81301-3647
TelephoneNmmber: ( 970 )- 247-4874
CC: STATE OR FEDERAL, LANDOWNER (if any)
Agency: Not Applicable
Street:
City:
State:
Zip Code:
Telephone Number: ( ) -