PERMFILE124716

• Permit No: M2002053
• IBM Index Class Name: Permit File
• Doc Date: 6/26/2002
• Doc Name: Application Form
• From: John R. Kurtzer
• To: DMG
• Section_Exhibit Name: Permit
• Media Type: D
• Archive: No

3
14. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: Sohn R. (Dick) Kurtzer Title: Operator
Company Name:
Street: 24463 County Road 11
Ci[y. Haxtun
State: CO Zip Code: 80731
Telephone Number: 9( 70 1- 774-7122
Fax Number: 9( 70 )- 774-3265
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name: SAME Tile:
Company Name:
Street:
City.
State: Zip Code:
Telephone Number: ( ) -
Fax Number: ~~ -
INSPECTION CONTACT
Individual's Name: SAME Title:
Company Name:
Street
City
State: Zip Code:
Telephone Number: ~~ -
Fax Number: (_~ -
CC' STATE OR FEDERAL LANDOWNER (if anyl
Agency. N/A
Street
City.
State: Zip Code:
Telephone Number: ~~ -
CC STATE OR FEDERAL LANDOWNER (if anvl
Agency. N/A
Street
City.
State: Zip Code:
Telephone Number: ( ) -