2010-12-22_PERMIT FILE - M2010084

• Permit No: M2010084
• IBM Index Class Name: PERMIT FILE
• Doc Date: 12/22/2010
• Doc Name: New 110c permit application
• From: Lost Cause, LLC
• To: DRMS
• Email Name: THM
• Media Type: D
• Archive: No

-2-
11. Correspondence Infor mation:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: Tim Mantle Title: Officer
Company Name: Lost Cause, LLC
Street/P.O. Box: 27002 CR5 P.O. Box:
City: Rifle
State: Colorado Zip Code: 81650
Telephone Number: ( 970 ) _ 878-5303
Fax Number: ( 970 ) _ 878-5303 OR [phone]

PERMITTING CONTACT (if different from applicantloperator above)
Contact's Name: Roberta Tabor Title:

Company Name:
Street/P.O. Box: P.O. Box: 266
City: Loma
State: Colorado Zip Code: 81524
Telephone Number: ( 970 1-216-9988
Fax Number: ( 970 ) _ 986-8728

INSPECTION CONTACT
Contact's Name: Michael Frick Title:

Company Name:
Street/P.O. Box: P.O. Box: 266
City: Loma
State: Colorado Zip Code: 81524
Telephone Number: ( 970 1-250-2580
Fax Number: ( 970 ) _ 986-8728

CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:

Street:

City:

State: Zip Code:

Telephone Number: f ) -

CC: STATE OR FEDERAL LANDOWNER (if any)

Agency:

Street:

City:

State: Zip Code:

Telephone Number: ( ) -