2017-05-03_REPORT - M2004084

• Permit No: M2004084
• IBM Index Class Name: REPORT
• Doc Date: 5/3/2017
• Doc Name: Annual Fee/Report/Map
• From: Benson Bros.
• To: DRMS
• Annual Report Year: 2017
• Email Name: SJM
• 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: Hans Benson
Permittee Company: Benson Brothers
Address: 21240 Austin Rd
Austin,CO 81410
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: Michael L.Ripp
Company: MVR Resources, Inc.
Address: P.O. Box 54
Delta, CO 81416
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Ed Benson j414 w-s BENso tl
Company: Benson Brothers
Address: -2134150-R-a aiayd A0,STIMPd
Austin,CO 81410
Phone Number: [phone]
Fax Number:
Cq70)g35-flSG'7
Email Address:
I,the undersigns , hereby state that the information provided in this report is true and accurate, and that site operations are
being conduc in accordance with t n approved mining and reclamation plans.
h
Sign tune of Permittee o•a Cor te Officer,O ier,or Documented Desiunee D e
M�/