2016-12-09_REPORT - M1983194

• Permit No: M1983194
• IBM Index Class Name: REPORT
• Doc Date: 12/9/2016
• Doc Name: Annual Fee/Report/Map
• From: Nacholite Project
• To: DRMS
• Annual Report Year: 2017
• Email Name: THM
• Media Type: D
• Archive: No

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: Robert Warneke Kirk Daehling
Permittee Company: Natural Soda LLC
Address: 3200 CR 31
Rifle,CO 81650
Phone Number: [phone] [phone] ext. 114
Fax Number: [phone]
Email Address: [e-mail] [e-mail]
Permitting Contact: Robert Warneke Gerald Daub
Company: Natural Soda LLC Daub & Associates, Inc.
Address: 3200 CR 31 2241 S Broadway
Rifle,CO 81650 Grand Junction, CO. 81507
Phone Number: [phone] [phone]
Fax Number: [phone]
Email Address: [e-mail] [e-mail]
Inspection Contact: Robert Warneke
Kirk Daehling
Company: Natural Soda LLC
Address: 3200 CR 31
Rifle,CO 81650
Phone Number: [phone] [phone] ext. 114
Fax Number: [phone]
Email Address: [e-mail] [e-mail]
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.
""�- 142 1,7- S —/4
Signat a of Perm' ee.Corporate Officer,Owner,or Documented Designee Date
M-AF-02