PERMFILE118052

• Permit No: M2005060
• IBM Index Class Name: Permit File
• Doc Date: 8/17/2005
• Doc Name: Reclamation Permit Application Form
• From: DMG
• To: Weld County
• Media Type: D
• Archive: No

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14. Corresooodence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: Greg Nelson Title: Mining Supervisor
Company Name: Weld County Public Works
Street/P.O.Box: 1111 H Street P.O.Box: 75R
City: Greeley
Slate: Colorado Zip Code: R063~
Telephone Number: (970 1- 356-4000 X 3750
Fax Number. (970 1- 304-6497
PERMITTING CONTACT (if differ®t from applicanUoperator above)
Contact's Name: Title:
Company Name:
Sireet/P.O. Box: P.O. Box:
City:
State: Zip Code:
Telephone Number: ( 1-
Fax Nmnber: ( 1-
Contact's Name:
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number:
Fax Number:
CC: STATE OR FEDERAL LANDOWNER (if anvl
Agency:
Sffeet:
Title:
P.O. Box:
Zip Code:
City:
State:
Telephone Number: ( 1-
CC: STATE OR FEDERAL LANDOWNER (if anyl
Agency:
Street
City:
State:
Zip Code:
Zip Code:
Telephone Number: 1 ) -