2011-01-27_REVISION - M2005065

• Permit No: M2005065
• IBM Index Class Name: REVISION
• Doc Date: 1/27/2011
• Doc Name: Notices ‎(CN-01)‎
• From: DRMS
• To: Various
• Type & Sequence: CN1
• Email Name: DMC
• Media Type: D
• Archive: No

0
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11. Corresoondenee Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
ContacesName: -Ta rk Clark, Tr- Title: Owner
Company Name:
StreeVP.O. Box: P.O. Box: 787
City: S i lver t on
State: Colorado Zip Code: 8143 3
Telephone Number: ( 970 ) - 3.87-5243
Fax Number. ( 1-
P AUM ING CONTACT (if different from applicanVoperator above)
ContacCsName: Charles R. Ponchak TitlcGeolocrica l, consultant
Company Name:
SUVeVP.O. Box: 1 5 2 9 2 6050 Rd P.O. Box:
City:
State:
Telephone Number.
Fax Number:
INSPECTION CONTACT
Contacts Name:
Company Name:
StreeVP.O. Box:
C'
P.O. Box:
Wft
State: Zip Code:
Telephone Number.. f ) -
Fax Number. { ) -
CC: STATE OR FEDERAL LANDOWNER (if W
Aamew
Street:
City:
State: Zip Code:
Telephone Number f ) -
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State:
Telephone Number.
Montros
Colorado zip Code 81403
( 970 )-249-2081 970-249-4434
( 970 1- 249-2081
Tank Clark., jr Tide: ^wv%Mr
zip Code: