PERMFILE121272

• Permit No: M2007014
• IBM Index Class Name: Permit File
• Doc Date: 3/6/2007
• Doc Name: New 112c Appl
• From: Larsen Colorado LLC
• To: DRMS
• Media Type: D
• Archive: No

-3-
1 L Correspondence Information:
APYLTCANT/OPERATOR (name, address, and ptrotre of name to be used on permit)

Contact's Name:
~~.,rs, tF L~23t~.1 _
Title: ,, ~t
lv y~aR6EY
Company Name: LARSE+J Co...eRnna
Street/P.O. Box: °YL'1 k i~H wAY ITS P.O. Box: ~b
City: ~f Ewt¢c5E
State: Gen~2e>ao Zip Code: f3t2~1r~
Telephone Number. ('11°1 1- ~7 -111 ~ 20 (~
Fax Number: ( ~1°~„)- ~7~ -J~1~
PERMITTING CONTACT (if different from applicantloperator above)
Contact's Name: ~AtI~L C-~-/*iZ1C Title:
CortgtatryNartte: Ca_A2IL ~ nNNCr a~r:2hefS L! t
Street/P.O-Box: CaCi~2 S• /yEY.t/$2'r .5T" P.O.Box:
city: ( .En)~Cl:A.V~/t 4ly
State: ~ ao2 ALa Zip Code: ~ 1l 1
Telephone Number: ( 3cL3 1- 22t - CoSf'A
Fax Number: ( J' 03 1 - Z2 ~ - (oS~
INSPECTION CONTACT

• Contact's Name:
__d„~o28/E LA.2SEA.)
L
Title: ^ ,~
1 `r1AnlAG~E~2
compa,ty Name: a;ese,.1 C~ne~.~-,
Saeet/P.O. Box: 9Z'1 ~/oNuA'~ //s P.O. Box: ~~~
City: of Ery2a5E
State: Goal?oA~ Z.ip Code: 8/Z'th
Telephone Number: ( 7t9 )- 37Z 711'1 X2ofe
Fate Ntmdter. ( `1 t°t ) - 37 7_ 7 I I ~
Agenry:
Street:
City:
State:
Telephone Number.
Agency:
Street:
City:
State:
Zip Code:
Zip Code:
'T'elephone Number: ( 1-