2015-03-18_REVISION - M2012032

• Permit No: M2012032
• IBM Index Class Name: REVISION
• Doc Date: 3/18/2015
• Doc Name: Notices AM01
• From: DRMS
• To: Various
• Type & Sequence: AM1
• Email Name: RCO
• Email Name: GRM
• Media Type: D
• Archive: No

-4-
P.O. Box:
Correspondence Information:
APPLICANT /OPERATOR (name, address, and phone of name to be used on permit):
Contact's Name: Mike Romaniuk
Title: VP & COO
Company Name: Fortune Revenue Silver Mines, Inc.
Street: 1900 Main Street, Unit 1
P.O. Box: 564
City: Ouray
CC: STATE OR FEDERAL LANDOWNER (if any):
State: Colorado
Zip Code: 80147
Telephone Number: .(970 _ 325 -9830
Street: 2505 S. Townsend
Fax Number. ( 970 L _ 325 -9824
Cm,, Montrose
PEPM91TING CONTACT (if different from applicant/operator above):
State: Colorado
Contact's Name: same as above
Title:
Company Name:
CC: STATE OR FEDERAL LANDOWNER if any):
Street:
P.O. Box:
City:
State:
Zip Code:
Telephone Number: l Z
Fax Number:
State:
Contact's Name: Title:
Company Name:
Street:
P.O. Box:
City:
State:
Zip Code:
Telephone Number: f 1
Fax Number. ( L -
CC: STATE OR FEDERAL LANDOWNER (if any):
Agency: US Forest Service
Street: 2505 S. Townsend
Cm,, Montrose
State: Colorado
Zip Code; 81401
Telephone Number: _( 970 _ 240 -5300
CC: STATE OR FEDERAL LANDOWNER if any):
Agency:
Street:
City:
State:
Zip Code:
Telephone Number: