2010-12-08_REVISION - M1981185

• Permit No: M1981185
• IBM Index Class Name: REVISION
• Doc Date: 12/8/2010
• Doc Name: Application for CN-01 incomplete for the purposes of filing
• From: DRMS
• To: R Squared Incorporated
• Email Name: WHE
• Media Type: D
• Archive: No

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Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit):
Contact's Name: ?Cere?C?Ro?n93et} fCcsgca, r?-i c toGn4or Title: 'GOMSUKWIA' Pre,siden?
Company Name: W i li Cct f M o n t n a G: ?o rzJ1a-1
Street: I<v3 U k'?n lip B13) y ca ,
ox:
City: Greemwoed Vi 11 age-,e&,-8bttt cif <? o,

State: -GeierT' Ftori a , i
ZipCode: "S9H1 13
99
Telephone Number: t - ) Y? ?P_Qc: t f{?e ? /V ,M 1
Fax Number:
$3r-? ) =-8 r I Vvt
I WX
PERMITTING CONTACT (if different from applican operator a ove
Contact's Name: George Robinson Title: Consultant
Company Name: R Squared, Incorporated
Street: 5555 DTC Parkway - Suite A-4000 P.O. Box:
City: Greenwood Village,
State: Colorado Zip Code: 80111
Telephone Number. (303 832.7664
Fax Number: (303 832.7469
INSPECTION CONTACT:
Contact's Name: George Robinson Title: Consultant
Company Name: R Squared, Incorporated
Street: 5555 DTC Parkway - Suite A-4000 P.O. Box:
City: Greenwood Village
State: Colorado Zip Code: 80111
Telephone Number: 303 832.7664
Fax Number: (303 _ 832.7469
CC: STATE OR FEDERAL LANDOWNER (if any):
Agency: Not applicable
Street:
City:
State: Zip Code:
Telephone Number:
CC: STATE OR FEDERAL LANDOWNER (if any):
Agency: Not applicable
Street:
City:
State: Zip Code:
Telephone Number:
--X-