2017-01-17_REPORT - M1977256

• Permit No: M1977256
• IBM Index Class Name: Report
• Doc Date: 1/17/2017
• Doc Name: Annual Fee/Report Notice
• From: DRMS
• To: Grand County
• 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:

Bill Clark
Permittee Company:

Grand County
Address:

P.O. Box 9
Granby, CO 80446

Phone Number:

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

Steve O’Brian
Company:

Environment, Inc.
Address:

7985 Vance Dr Ste 205A
Arvada, CO 80003

Phone Number:

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

Ken Haynes
Company:

Grand County
Address:

P.O. Box 9
467 E. Topaz Ave.
Granby, CO 80446

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-04