2016-12-15_REPORT - M2006078

• Permit No: M2006078
• IBM Index Class Name: REPORT
• Doc Date: 12/15/2016
• Doc Name: Annual Fee/Report/Map
• From: Flatiron Constructors, Inc.
• To: DRMS
• Annual Report Year: 2016
• Email Name: PSH
• 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: 3nstin-Bnibferid
Perrnittee Company: Flatiron Constructors,Inc.
Address: 10188 E.125 Frontage Rd. `
Firestone,CO 80504 3 g 5 1^'-��' `oc,��c� C►�,s ce- '���p0
l5►o©n�:a lc�. � CC) g 0©21
Phone Number: [phone]
4672 5 1
Fax Number: [phone]
Email Address: `� O��'1 ^ n
1 c. i/ Cry G a i . C. o^�
Permitting Contact: Mike Hart
Company: Hart Environmental
Address: P.O.Box 1303
Boulder,CO 80306
Phone Number: [phone]
I
Fax Number: [phone]
Email Address:
Inspection Contact:
Company: Flatiron Constructors,Inc.
Address: 10188 E.I25 Frontage Rd. I1
Firestone,CO 80504
Phone Number: [phone] 5
Fax Number: [phone]
Email Address: ujo
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.
12,f/c 1,6
Sigma re of Permittee,Corporate Officer,Owner,or Documented Designee Date
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M-AF-01
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