2011-03-02_PERMIT FILE - M2011017

• Permit No: M2011017
• IBM Index Class Name: PERMIT FILE
• Doc Date: 3/2/2011
• Doc Name: New 110c permit application
• From: Breeze Basin Resources
• To: DRMS
• Email Name: DMC
• Media Type: D
• Archive: No

-2-
City: Hayden
State: -CO
Telephone Number: ( 9 7 0 326-8689
Fax Number: ( 979 ?- 824-2840
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name:
Company Name:
Street/P.O. Box:
City
P.O. Box:
State: Zip Code:
Telephone Number: ( ) -
Fax Number: ( -
INSPECTION CONTACT
Contact's Name: Rick Domson Title: Sec/Treas.
Company Name: Breeze Basin Resources
Street/P.O. Box: P.O. Box: 181
City: Hayden
State: -CO Zip Code: 81639
Telephone Number: ( 9 7 0 3 2 6- 8 6 8 9
Fax Number: ( 9 7 0- 824-2840
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State:
Telephone Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State:
11. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: Rick Domson
Company Name: Breeze Basin Resources
Street/P.O. Box:
Title:
Title: Sec/Treas
P.O. Box: 181
Zip Code: 81639
Zip Code:
Zip Code:
Telephone Number: