2017-01-17_REPORT - M1977526

• Permit No: M1977526
• IBM Index Class Name: Report
• Doc Date: 1/17/2017
• Doc Name: Annual Fee/Report Notice
• From: DRMS
• To: Albert Frei
• 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:

Ben Frei
Permittee Company:

Albert Frei & Sons Inc.
Address:

P.O. Box 700
Henderson, CO 80640-0700

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:

Ben Frei
Company:

Albert Frei & Sons Inc.
Address:

P.O. Box 700
Henderson, CO 80640

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