2013-01-04_REVISION - M1977193

• Permit No: M1977193
• IBM Index Class Name: REVISION
• Doc Date: 1/4/2013
• Doc Name: AMMENDMENT APPLICATION
• From: TEZAK
• To: DRMS
• Type & Sequence: AM5
• 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)
Contact's Name.
'ANON D I Luz( 0
Title: Treasurer
Company Name Tezak Heavy Equipment, Inc./ T.H.E. Aggregate Source
Street/P.O. Box: 205 Tunnel Drive P.O. Box:
City Canon City
State CO Zip Code: 81212
Telephone Number ( 719 ) - 269 -1173
Fax Number: ( 719 ) - 269 -1148
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name Kenneth S. Klco Title: Consulting Geologist
Company Name: Azurite, Inc.
Street/P 0 Box P O Box 338
City: Cotopaxi
State CO Zip Code. 81223
Telephone Number: ( 719 - 942 -4178
Fax Number: ( 719 ) - 942 -4178
INSPECTION CONTACT
Contact's Name: Randy Diluzi ✓ Title General Manager
Company Name: Tezak Heavy Equipment, Inc. / T.H.E. Aggregate Source
Street/P.O. Box 205 Tunnel Drive P O. Box:
City- Canon City
State: CO Zip Code: 81212
Telephone Number ( 719 ) _ 269 -1173
Fax Number: ( 719 ) - 269 -1148
CC: STATE OR FEDERAL LANDOWNER (if any)
United States Bureau of Land Management Royal Gorge Field Office
Agency:
Street
City Canon City
3028 Main Street
State: CO Zip Code: 81212 -2731
Telephone Number: ( 719 ) - 269 -8500
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State Zip Code:
Telephone Number: ( ) -