2008-04-25_REVISION - M1992113

• Permit No: M1992113
• IBM Index Class Name: REVISION
• Doc Date: 4/25/2008
• Doc Name: New Amendment Appl
• From: Bent County
• To: DRMS
• Type & Sequence: AM2
• Media Type: D
• Archive: No

-3-
11. Corresponde..nce Information:
APPL.ICAN'T1OPF,RA'T'OR (name, address, and phone of name to be use-d on permit) ADM . ~yj.~ ~.T
Contact's Name: ~' X14- ik '"'g_, F~___R~!~N~ Title: P~,~ ~~ ~~!~!!~s~an/E~
Company Name: ~w~~r- ~" ~tp til`r`9 ~________
StreetlP.O. Box: ~,,Q__E-~1__~7 X ~ J .5'~ --- P.O. Box:
City: ~ FFS A N~/yrAS _._.- - _--------
State: _ Co ~-~2.A~na .------ Zip Code: ~lo .5~.-- ~~50
Telephone Number: L.'L~~ - ~-Slv -~~ ~-3 ___
Fax Number: (~/I 9 ~. - ~`fs~' " ®~ ~ZS - -
PERMITTING CO1V'CAC'T (if different from applicant/operator above)
Contact's Name: '.Citle: ____
Company Name:
Street'P.O. Box:
City:
State:
Telephone Number:
Fax Number:
INSPECTION CONCACI' ~~~~ M AN , ~F N ~ ~
Contact's Name: C; ' uR'r'~ S 1~= l= ~ `Title: (20#.0 . 3~N D ~ RT.O ~ ~
Company Name: ~~ ~ 1~1 1'- ~?? c.~Al ~! y ~
StreetlP.O. Box: P.O. Box: ~27
City: ~-- .A S 1411 Z M ±4S 1
State: ~~ ~--t7 Q A~1~'D lip Code: ~"©S!~
'T'elephone Number: (~ / `~ ) - -~ ~-~~ ----
Fax Number: c "Z/ 9 ~ - "- ~ -3 y
CC: STATF, 012. FEUEi2.AL I,ANDOWNF.,R if an
Agency:
Street:
~ _~ -
( )-
P.O. Box:
7..ip Code:
City: .................._..................._............,......,..........-/
State: ~.,.....~...._ .........................................._._.................
Telephone N~.Trnber: f ........-------- -__-......--..) - .. ----...-
C'C.__S'TA'I'~_C)R ~I_I)I`sR~i. I,A'~I)t3W;ti1~-R_~it anyl
Agency:
Street:
City: !"''
State:
Zip Code:
Tip C'c>de:
't`elephone Niu~ztber: ~ ...............................__-....1. -