PERMFILE115463

• Permit No: M2004057
• IBM Index Class Name: Permit File
• Doc Date: 8/24/2004
• Doc Name: Application
• From: Bent County
• To: DMG
• 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:
Company Name: Cn
~ F Nr `P c
C o u nr r~ Title: CtJ. A OnnxNS ST CLIQ rTj~
Street/P.O. Box: "7 ~- ~ ~ E N T A y E N u E P.O. Box: 3 50
City: LAS FaNxMiA~

State: C c3 L r J 12 p b o Zip Code: $ 1 D 5 ~! - 0 3~ o
Telephone Number: ('~7 ~ 9 1- ~l- 5 ~ - ~- 3..z'3
Fax Number: ( `7 19 1- t-! 5[.. - f~ 3 "fs
PERMITTING CONTACT (if different from applicant/operafor above)
Contact's Name:
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number:
Fax Number:
Title:
P.O. Box:
Zip Code:
Coniact'sNeme: G~'g~ 1_ u -P R r'T cNlaRD Title: ca. /-.DMSNS $T1z~rp~
Compaq Name: ~~ EN i C_ n uN T `1
Street/P.O. Box: r`J 2 5 ~ E N'T A V E n, u ¢' P.O. Box: ~ 5'd
City: L. A S H N r nn A
State: ~o L,o f1 AD a Zip Code: 4~ 1 O 5 H - O 35'0
Telephone Nwnber: / 9 ~} ~ f<, - ~ ~- ~-3
Fax Number: ~7f 1._~ - ~ 5L - a _~ ~'T ~
CC: STATE OR FEDERAL LANDOWNER~(if~an~
Agency: A/ ~!
Street:
Telephone Number: ( ) -
City:
State:
Zip Code:
CC: STATE OR FEDERAL LANDOWNER (if and
Agency: ~ ~
Ciry:
State:
Telephone Number: ( ) -
Street:
Zip Code:
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