PERMFILE124574

• Permit No: M2005021
• IBM Index Class Name: Permit File
• Doc Date: 9/15/2005
• Doc Name: Amendment to Permit Application
• From: Greg Lewicki & Associates
• To: DMG
• Media Type: D
• Archive: No

-3-
I I. Correspondence Information:
APPLICANT/OPERATOR (nam/e~, address, and phone of name to be used on permit)
Contact's Name: IJ~en~ ~Lrf Title:
ComparryNeme: QIOG0.S~'IP $w GwNP. T-nG, d6g ~n~
street/P.o. Bnx:
City:
scare:
Telephone Number:
Fax Number:
P 0 (3ox 3 6oq ~ P.o. Box:
GrAn~D S~.nc~~an
Colorado Zip Code: 8I 5Oa
r `i'1O ~_ ay3-4goo
r °t~a ~- a4a- sayr
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name:
Company Name:
StreeUP.0. Box:
City:
state:
Telephone Number:
Fax Number:
INSPECTION CONTACT
Contact's Name:
Company Name:
Street/P.O. Box:
City:
State:
Telephone Number:
Fax Number:
Title: E~U;nitf
zip code: X013 8
Zip Cale: ~ ~ ~ a
~o - a~13- 4goo
( ~~o )_ a~~ _ 5945
CC: STATE OR FEDERAL LANDOWNER (if eny)
Agency:
Street:
City:
State: Zip Code:
~'elephone Number: ( 1-
CC• STATE OR FIDERAL LANDOWNER (if anv)
Agency:
Street:
City:
State: Zin Code:

Telephone Number: ( 1-
r 303 ~- 396-S1g6
3r o3 ,_ 3HS- 643H
P o 1box 3609 P.o. Box:
G('gn0 Tunr ~-lon