PERMFILE124234

• Permit No: M2006072
• IBM Index Class Name: Permit File
• Doc Date: 9/22/2006
• Doc Name: 112c application
• From: Jeffrey L. Schumacher
• To: DRMS
• Media Type: D
• Archive: No

-3-
11. Corresoondenee Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
~ay L.Schumacher
Contact's Name: Jeff Title: Owner
,
Company Name:

StreedP.O. Box: 831 Park Street P.O. Box:
City: Sterling
State: CO Zip Code: 80751
Telephone Number: ( 970 )- 552-6979

Fax Number: ( ) -

PERMITTING CONTACT (if different from applicant/operator above)
Con[act'sName: Rand~t Schafer Title: Consultant

Company Name:

StreeUP.O. BOX: 4Q5R6 ('n. RA - 21 P.O. Box:
City: Haxtun
State: ~n 'Lip Code: 80731
'Telephone Number: { q7{S)_ R54 4778 ( nr ) 970-774 -6264 (home)

Fax Number: ( 970 1- $54-4811
INSPECTION CONTACT
Contact's Name: Rrar,t flrr Title: _ Operator
_
Company Name:

Strect/P.O.IIox: 35200 Co. Rd. DD.75 P.O. Box:
City: Wra3.

Sfate: r:n Z.ip Code: 80758 _
Telephone Number. ( 979 )- 332-5000

Fax Number. ( 1-
CC: STATF, OR FEDERAL. LANDOWNER fifanvl
Agency:
_
Sttett:
C;ty: ---- -

State: __ ____ , Zip Code: _
Telephone Number: ( ) - __
___
CC: S"CA"f F, OR FEDERAL LANDOWNER fif anv)
Agency:

Street:

City: -- -- -------

State: __ __ _~ 7,ip Code: __ ___
Telephone Number. (___) - ___ _______v. _