2017-01-17_REPORT - M2006054

• Permit No: M2006054
• IBM Index Class Name: Report
• Doc Date: 1/17/2017
• Doc Name: Annual Fee/Report Notice
• From: DRMS
• To: ORDWAY FEEDYYARD
• 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:

Adam Larson
Permittee Company:

ORDWAY FEEDYARD LTD.
LIABILITY CO.

Address:

19424 Hwy 96
Ordway, CO 81063

Phone Number:

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

Adam Larson
Company:

Ordway Feedyard LTD Liability
Co

Address:

19424 Hwy 96
Ordway, CO 81063

Phone Number:

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

Adam Larson
Company:

Ordway Feedyard LTD Liability
Co.

Address:

19424 Hwy 96
Ordway, CO 81063

Phone Number:

[phone]
Fax Number:
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