2008-10-21_PERMIT FILE - M2008072

• Permit No: M2008072
• IBM Index Class Name: PERMIT FILE
• Doc Date: 10/21/2008
• Doc Name: New 110c Appl.
• From: Randy Schafer for Tim Carper
• To: DRMS
• Media Type: D
• Archive: No

-2-
11. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: Tim Carper_ ,_ - Title: Owner/ Operator
Company Name:
Street/P.O. Box: 42538-Co Rr1---0 P.O. Box: ___-__-___
City: Ha x t i m

State: CO Zip Codc: 80731
Telephone Number: 7 7 4- 712 6
9 7 0 ) -
-
Fax Number:
PERMI'T°TING CONTACT (if different from applicantiloperator above)
Contact's Name: Rand Schafer 'T'itle: _
Company Name:

Street/P.O. Box: 40686 Co. Rd. 21 P.O. Box:
City: Ha x t ii n T

State: CO Zip Code: 80731
Telephone Number: ( 970 ) - 774-6264 (Home) 970-854-3778 (Work)

Fax Number: ( 970 ) - 854-3811
INSPECTION CONTACT
Contact's Name: Tim
Carper Title:
_
Company Name:

Street/P.O. Box: (same as above) P.O. Box:
City: ---

State: Zip Code:

Telephone Number:

Fax Number: (
1- - - - _
- - - - - - -- -
-- -
C;: STATE OR FEDERAL .LANDOWNER if an
Agency:
Street:
City:
State: Zip
Telephone Number: i. .__...._.._....... ....... ,). -
STATE OR FEDERAL LANDOWNER -(if any)
Agency:
Street:
City:
State: ... - .............___...._.._.._ _. Zip code: -...__.__...._-_
"T: elephone Number:
.._
(_ _._....._ ._.._.._...._..1 ' -----------