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IU. i;omsponarnce ln[OiRlallon. <br />APPLICA*1TlOPERATOR: (name, address, end phone of name to be used on pemut) <br />Contact's Name Tlratnea Hrutbr, Attlne Mill Mane err Gwea Fneer. Predfatt <br />Company Nsme• C.O.N. Ina <br />Suter PO B~: 173N J7{0 W. Narelnel Wtu S.W. <br />City• Bwldr _ _ Se~tlL <br />S4te CO tiB711~0701 WA l~14f <br />Pnone' cson.ffv-nff <br />PERMTITING CONTACT (ifdttTerrnt from eppLcanVUDerator above) <br />lndivrdual's Name: Ttaamn HartMy Tole: ~; MW Mwatw <br />Cottrpeny Name: <br />Street. <br />Ci[v <br />S4te. <br />Lp <br />Arta Code: 307 Telephone: If9-77f6 <br />INSPECTION CONTACT <br />Irxti~idual'e Nynr. Tha4»r klar•t1eY lYde: Actl~~ M01 Mu~[M <br />Company Nemc C.O.M ttx <br />CtmrF PO poi 1730f <br />City: Balddac <br />S4te: CO Zip Cock: 44_^.~~'~` <br />Arco Code: ~7-_ Tekphone: IfR77{f <br />c.•t.•: ~IArcuxrtucxA>_.t.ArvlluwNtxtuanvt <br />ngrncy: buexAO Ot Laos Maoeewrenr - _ _w -___ <br />Street: x170 halt til~>a~]Ih'ER _ <br />Clry f lalrYQtICItP <br />3Wrc. CO Ziy Gudc. !1212 <br />area (:nde: Telephone. <br />CC: STATE OR FEDERAL LANDOWNER (iCanyj <br />Agenoy <br />Sheet: --.__--. _. . <br />Crty. <br />$4te~. ___ Zip Codr <br />Area Code: Telephone: <br />I I Pnmery fututt (post-mining) land uee fa eok one. <br />_ Cropland (CR) _ Psatweland (PL) Oerrerel Agnculture (GA) <br />Rangtland (RL) _^ Forestry (FR) X Wildlife Habitat (WL) <br />_ Residential (RS) _ Rocrcation (RCl _ InduatriaUCommccvl (TC) <br />Developed Wstet Rnorucee (WR) ,Solid Weate Disposal (WD) <br />l l Primary present lend use (check one) <br />_ Cropland (CRl Paatutelend (Pl.) _ Geneeal Agnculhue (GA) <br />Rangeland (RLf _ Forestry (FR) _ Wildlife Habitat (WL) <br />_ Resrdential (RS) _ Recreatlon (RC) 7~ Indust[iellCommctclal (TC) <br />Developed Water Resortmes (WR) ~ Mining (MN) <br />l3 if this operetion will rsse designated chemicals, or will ttstilt, or presently has acid mint drainage -you cannot uac this <br />application form. You must submit either s I If)d or I ltd application form for Designated Mining Openttions. In either <br />case, you must list any acidic or toxic-forming mattrial5, exposed or disturbed as a result of the inuring operation, acrd <br />whether the operation will result N. or presently has acid mine dreurage~ _ <br />Description of Conyesaion: <br />fi you ere converting en ewehng optretion, pro+nde a brief natrahve deacnbmg fhe proposed change(s). <br />