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-3- <br />11. Correamedence Information: <br />~1PPLiCANT/OPERATOR re <br />ss, and phone of name to be used on permit) <br />(nam <br />e <br />, <br />ad <br />d <br />Contact's Name: ~ <br />f <br />- <br />/n~ <br />l <br />t <br />~12'~T C~t-ESA Title: ~OtJKCe$ t'~QnQQer <br />Company Name: ffLll~~-U"L~i~) C~iv~ra-Iron <br />streetlP.o. atx: 30 / L'eH-fen n is / Dr) / e, <br />~ P.o. amt: <br />City: i~I~keF~ <br />m <br /> <br />Slate: /y <br />/ <br />LC~~DfRc~U p <br />Zip Code: 6 OJr ~ 3 <br />Telephone Number. (~ 7O ) -Jr g / ' 7 a~~ <br />Fax Number: (q ~ o , - 35,E - Gab y <br />PERMITTRJG CONTACT /operatorebove) <br />(if diderent from applicanl <br />Contact's Name: l1 <br />~Q n n Ol 0 rTt Z Tile: f la n n e,e <br />Company Name: C~~•i iee $OtlQC25 <br />StreetlP.o.Box: ~{K) OA~ Sd-y She 20q P.O.Box: (08"0 <br />city: ~Rec~efie% <br />State: CO Zip Code: ~~JC-3 <br />Telephone Number: ? <br />3D - ~.33 - I ~I y+ P~l-~' _~ <br />Fax Number: ( 303 ~- 833- a~r0 <br />INSPECTION CONTACT <br /> <br />Contact's Name: _ /~ p /~ <br />1°Y-T Vre4A <br />~ `'~ ,~y~ <br />Title: /C.i°.$Ot)RCCS //t411gQe/- <br />CompatryName: /~ <br />r_ <br />ltlill" SYWiI" CO(,,~Dfq,~'iowl <br />streeuP.o.aox: 301 C`'en~ennia( .priJt P.o.6ox: <br />Ciry: '}'lt I~~ fLCtu <br />! <br /> n <br />'O <br />r~~0 p <br />45 ~ <br />3 <br />State: 1 O <br />> - <br />Zip Code: O <br />Telephone Number: c 9~b 1- .StF ~ " ~.tao <br />Fax Number: 7 ~ - 3 J o~' /s o2g <br />CC: STATE OR FEDERAL LANDOWNER !if any] <br /> <br />Agency: <br /> <br />Street: <br />City: <br /> <br />State: Zip Code: <br /> <br />Telephone Number: f 1 - <br /> <br />CC: STATE OR FF,DERAL LANDO WNER (if and <br /> <br />Agency: <br /> <br />Street: <br />Cits': <br />State: 7.ip Code: <br /> <br />Telephone Number: ~ ) - <br />