2017-02-08_REPORT - M1983194

• Permit No: M1983194
• IBM Index Class Name: REPORT
• Doc Date: 2/8/2017
• Doc Name: Annual Fee/Report/Map
• From: Natural Soda, LLC
• 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.
-j/- 1*7
Signature ofiKrmittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-02