2017-03-17_REPORT - M1976051

• Permit No: M1976051
• IBM Index Class Name: Report
• Doc Date: 3/17/2017
• Doc Name: Annual Fee/Report Notice
• From: DRMS
• To: Duckels Construction
• Annual Report Year: 2017
• Permit Index Doc Type: Annual Fee/Report
• 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:

Fred A. Duckels
Permittee Company:

Duckels Construction, Inc.
Address:

3500 Duckels Court
Steamboat Springs, CO 80487

Phone Number:

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

Bruce Humphries
Company:

Regulatory Permits
Management, Inc.

Address:

7425 Winter Beryy Ln
Castle Rock, CO 80108

Phone Number:

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

Fred Duckels
Company:

Duckels Construction, Inc.
Address:

3500 Duckels Court
Steamboat Springs, CO 80487

Phone Number:

[phone]
Fax Number: [phone]
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