2017-04-17_M1983216_Annual Fee Notice ARCHIVE

• Permit No: M1983216A
• IBM Index Class Name: Report
• Doc Date: 4/17/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Mesa County
• Annual Report Year: 2017
• Media Type: D
• Archive: Yes

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:

Rudy Bevan
Permittee Company:

Mesa County
Address:

P.O. Box 20000-5025
Grand Junction, CO 81502

Phone Number:

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

Robert Carman
Company:

Mesa County
Address:

P.O. Box 20000-5025
Grand Junction, CO 81502-
5025

Phone Number:

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

Robert Carman
Company:

Mesa County
Address:

P.O. Box 20000-5025
Grand Junction, CO 81502-
5025

Phone Number:

[phone]
Fax Number:
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