2017-03-31_REPORT - M1977062

• Permit No: M1977062
• IBM Index Class Name: Report
• Doc Date: 3/31/2017
• Doc Name: Annual Fee/Report/Map
• From: Benson Brothers
• To: DRMS
• Annual Report Year: 2017
• Email Name: SJM
• 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:
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Permittee Company:
Benson Brothers
Address:
21240 Austin Rd
Austin, CO 81410
Phone Number:
[phone]
Fax Number:
[phone]
Email Address:
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Company:
Benson Brothers
Address:
21240 Austin Rd
Austin, CO 81418
Phone Number:
[phone]
Fax Number:
Email Address:
Inspection Contact:
Dwight D. Benson
Company:
Benson Brothers
Address:
21240 Austin Rd
Austin, CO 81418
Phone Number:
[phone]
Fax Number:
Email Address:
I, the unrsigned, hereby state that the information provided in this report is true and accurate, and that site operations are
being 96n4ucted in accordance with thy, Division approved mining and reclamation plans.
of Per ittee Corporate Officer, Owner, or Documented Designee Date
M -AF -01