2016-12-16_M2000099_Annual Fee Notice ARCHIVE

• Permit No: M2000099A
• IBM Index Class Name: Report
• Doc Date: 12/16/2016
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Marilyn E. Diamond, Bruce A Diamond
• 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:

Marilyn E. Diamond
Permittee Company:

Marilyn E. Diamond, Bruce A
Diamond

Address:

26520 CR 301
Buena Vista, CO 81211

Phone Number:

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

Jonathan A. Roorda
Company:

Arkansas Valley Surveying
Address:

P.O. Box 1111
31320 CR 384A
Buena Vista, CO 81211

Phone Number:

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

Marilyn E. Diamond
Company:

Marilyn E. Diamond, Bruce A
Diamond

Address:

26520 CR 301
Buena Vista, CO 81211

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