2016-12-16_M2001108_Annual Fee Notice ARCHIVE

• Permit No: M2001108A
• IBM Index Class Name: Report
• Doc Date: 12/16/2016
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Alamosa County
• Annual Report Year: 2017
• 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:

Tim DeHerrera
Permittee Company:

Alamosa County
Address:

8663 S. CR 109
Alamosa, CO 81101

Phone Number:

[phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact:

Phil West
Company:

Alamosa County
Address:

P.O. Box 178
Alamosa, CO 81101

Phone Number:

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

Phil West
Company:

Alamosa County
Address:

P.O. Box 178
Alamosa, CO 81101

Phone Number:

[phone]
Fax Number:
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-04