PERMFILE121750

• Permit No: M1992100
• IBM Index Class Name: Permit File
• Doc Date: 10/2/1992
• Doc Name: Limited Impact Operation 110 2 Reclamation Permit Application Form
• Media Type: D
• Archive: No

11
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9. Correspondence Information:
APPLICANT/OPERATOR (name, address, ~~a77nd,phone of name to be used on permit)
Individual's Name: 12;dE2 ,oo7TUM Lg r.)D ('vaA
Company Name: 12~ Je2 r3.,tl•~,~,-. L.u..,.~ C`orn
Street: 14a.S NnnS Lvi
city: ~~.,-,-, ;
State: !`~, Zip Code: 814x$
Area Code: 303 Telephone: Sal-'f'/3~
PERMITTING CONTACT <if different from applicant/operator above)
Individual's Name: I~c~~-,-;cic Fa.r~air~or`I-t~
Company Name: IZi JQ IZ '. )'Jo~vv~ Lo,~,r~ Cn r~7
Street:
City:
State:
Area Code:
INSPECTION CONTACT
Individual's Name
Company Name:
Street:
City:
State:
Area Code:
Telephone:
Zip Code:
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency: ~~a
Street:.
City:
State:
Area Code: Telephone:
Zip Code:
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency: `"x`10.
Street:
City:
State:
Area Code:
Telephone:
Zip Code:
12iJER BoTto rv~ 1-AN~ CORM
Telephone:
Zip Code: