2017-04-28_REPORT - M2008018

• Permit No: M2008018
• IBM Index Class Name: Report
• Doc Date: 4/28/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Flying Triangle Ranch , LLC
• Annual Report Year: 2017
• 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:

Cliff Henderson
Permittee Company:

Flying Triangle Ranch , LLC
Address:

12602 US HWY 26
Riverton, WY 82501

Phone Number:

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

Cliff Henderson
Company:

Flying Triangle Ranch , LLC
Address:

785 22 Road
Grand Junction, CO 08121-5000

Phone Number:

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

Cliff Henderson
Company:

Flying Triangle Ranch , LLC
Address:

785 22 Road
Grand Junction, CO 81505

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-01