2012-03-08_PERMIT FILE - M2012010

• Permit No: M2012010
• IBM Index Class Name: PERMIT FILE
• Doc Date: 3/8/2012
• Doc Name: New 112c Application
• From: Las Animas County
• To: DRMS
• Media Type: D
• Archive: No

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11. Corresnondence Information:
APPLICANT /OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: Phil Dorenkamp
Title: R &B Supv.
Company Name- Las Animas County
Street/P.O. Box: 2000 N. Linden Ave. P.O. Box:
City: Trinidad
State: Colorado Zip Code: 81082
Telephone Number: ( 719 1_ 846 -2931
Fax Number ( 719 ) -
846 -0434
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name. sam Title:
Company Name:
Street/P.O. Box: P.O. Box:
City:
State: Zip Code:
Telephone Number: ( ) -
Fax Number ( ) -
INSPECTION CONTACT
Contact's Name: sam Title:
Company Name•
Street/P.O. Box: P.O. Box:
City:
State: Zip Code:
Telephone Number ( ) -
Fax Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency: N/A
Street:
City:
State: Zip Code:
Telephone Number ( ) -
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency: N/A
Street:
City:
State: Zip Code:
Telephone Number ( ) -