2010-06-08_PERMIT FILE - M2010037

• Permit No: M2010037
• IBM Index Class Name: PERMIT FILE
• Doc Date: 6/8/2010
• Doc Name: New 112c Application
• From: Elva Masters and Randy Schafer
• To: DRMS
• 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: Elva Lllastws Title: Owner/Operator
Company Name:
Street/P.O. Box: 25901 US Highway 36 P.O. Box: 47
City: Anton
State: CO Zip Code: 80801
Telephone Number: (970 ) - 383-2345
Fax Number. (970 ) _ 383-2347
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: Randy Schafer Title: Consultant
Company Name:
Street/P.O. Box: 40586 Co. Rd. 21 P.O. Box:
City: Haxtun
State: CO Zip Code: 80731
Telephone Number: J970 854-3778 (Work), 970-774-6264 (Home) 970-520-0502 (Cell)
Fax Number: ( 970 ) _ 854-3811
INSPECTION CONTACT
Contact's Name: Elva Masters Title: Owner/Operator
Company Name:
Street/P.O. Box: same as above 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. ( ) -