2017-02-21_M2006081_Annual Fee Notice ARCHIVE

• Permit No: M2006081A
• IBM Index Class Name: Report
• Doc Date: 2/21/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Daniel J. Gaudreault and Barbara J. Gaudreault
• 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:

Daniel J. Gaudreault
Permittee Company:

Daniel J. Gaudreault and
Barbara J. Gaudreault

Address:

P.O. Box 69
Elizabeth, CO 80107

Phone Number:

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

Joe P. Gagliano
Company:

L.J. Development, Inc.
Address:

256 N Merrill Drive
Pueblo West, CO 81007

Phone Number:

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

Joe P. Gagliano
Company:

L.J. Development, Inc.
Address:

256 N Merrill Drive
Pueblo West, CO 81007

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