2017-05-16_REPORT - M2000028

• Permit No: M2000028
• IBM Index Class Name: REPORT
• Doc Date: 5/16/2017
• Doc Name: Annual Fee/Report/Map
• From: Mike Ferrero
• To: DRMS
• Annual Report Year: 2017
• Email Name: ECS
• 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: Mike A.Ferrero
Permittee Company: Mike A Ferrero
Address: 34320 Hwy 12
Trinidad, CO 81082
C
Phone Number: [phone]
Fax Number: [phone]
Email Address: '
Permitting Contact: Greg Lewicki
Company: Greg Lewicki and Associates /
Address: 9054 South Forrest Drive
Highlands Ranch, CO 80126
C
Phone Number: [phone]
C
Fax Number: [phone]
Email Address:
Inspection Contact: Larry Menegatti
Company: '
Address: 591 County Rd. 315
Walsenburg,CO 81089
Phone Number: [phone] ,C
Fax Number: ,
Email Address: y
w
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.
y
Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-O l