2009-06-05_REVISION - M2003024

• Permit No: M2003024
• IBM Index Class Name: REVISION
• Doc Date: 6/5/2009
• Doc Name: Conversion Application
• From: Phillips County
• To: DRMS
• Type & Sequence: CN1
• Media Type: D
• Archive: No

-3-
11. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: Randy Schafer Title: Administrator
Company Name: Phillips County
Street/P.O. Box: 221 S. Interocean Avenue
P.O. Box:
City: Holyoke
State: CO Zip Code: 80734
Telephone Number: ( 970 ) - 854-3778
Fax Number: ( 970 854-3811
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: same as above Title:
Company Name:
Street/P.O. Box: P.O. Box:
City:
State: Zip Code:
Telephone Number: ( ) _
Fax Number: ( ) _
INSPECTION CONTACT
C'ontact's Name: same as above Title:
Company Name:
Street/P.O. Box: P.O. Box:
City:
State: Zip Code:
Telephone Number: { ) _
Fax Number: ( ) _
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( ) _
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( ) _