2016-10-18_M2006078_Annual Fee Notice ARCHIVE

• Permit No: M2006078A
• IBM Index Class Name: Report
• Doc Date: 10/18/2016
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Flatiron Constructors, Inc.
• Annual Report Year: 2016
• Media Type: D
• Archive: Yes

Page 5 of 5

Division records indicate the following permittee/landowner contact information (blank fields indicate that we do not have
information on record). If this information is blank or not current , please type or print current contact information:

Permittee Contact:

Justin DuMond
Permittee Company:

Flatiron Constructors, Inc.
Address:

10188 E. I25 Frontage Rd.
Firestone, CO 80504

Phone Number:

[phone]
Fax Number: [phone]
Email Address:
Permitting Contact:

Mike Hart
Company:

Hart Environmental
Address:

P.O. Box 1303
Boulder, CO 80306

Phone Number:

[phone]
Fax Number: [phone]
Email Address:
Inspection Contact:

Justin DuMond
Company:

Flatiron Constructors, Inc.
Address:

10188 E. I25 Frontage Rd.
Firestone, CO 80504

Phone Number:

[phone]
Fax Number: [phone]
Email Address:

I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are
being conducted in accordance with the Division approved mining and reclamation plans.

Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date
M-AF-01