2016-12-16_M1985112_Annual Fee Notice ARCHIVE

• Permit No: M1985112A
• IBM Index Class Name: Report
• Doc Date: 12/16/2016
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Loloff Construction, Inc.
• 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:

Kelly Hodge
Permittee Company:

Loloff Construction, Inc.
Address:

801 8th Street, Suite 130
Greeley, CO 80631

Phone Number:

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

John Vazquez
Company:

Address:

106 Rock Bridge Ct.
Windsor, CO 80550

Phone Number:

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

Kelly Hodge
Company:

Northern Colorado Gravel &
Sand, LLC

Address:

801 8th Street, Suite 130
Greeley, CO 80631

Phone Number:

[phone]
Fax Number:
Email Address: [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.

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