2012-08-21_REVISION - M2004030

• Permit No: M2004030
• IBM Index Class Name: REVISION
• Doc Date: 8/21/2012
• Doc Name: UPDATED INFORMATION
• From: T BONE STONE
• To: DRMS
• Type & Sequence: CN1
• Email Name: MAC
• Email Name: TAK
• Media Type: D
• Archive: No

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11. Correspondence Information:
APPLICANT /OPERATOR (name, address, and phone of name to be used on permit)
Contacts Name: BM Tenom
Company Name: T -Bone Stone, Inc.
Street/P.O. Box: 2337 Emery Street
City: Longmont
State: CO
Telephone Number: ( 303 ) _ 435 -2495
Fax Number. ( 303 ) _ 776 -3839
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: (same) Title:
Company Name:
Street/P.O. Box: P.O. Box:
City:
State: Zip Code:
Telephone Number. ( ) -
Fax Number: ( ) -
INSPECTION CONTACT
Contact's Name: (same) Title:
Company Name:
Street/P.O. Box: P.O. Box:
City:
State: Zip Code:
Telephone Number. f ) -
Fax Number. ( ) -
CC: STATE OR FEDERAL LANDOWNER (if anvl
Agency:
Street:
City:
n/a
Title: OWNER
P.O. Box:
Zip Code: 80503
Agency:
Street:
City:
State: Zip Code:
Telephone Number. ( ) -
CC: STATE OR FEDERAL LANDOWNER (if anv)
n/a
State: Zip Code:
Telephone Number. ( 1 -