2017-06-27_REPORT - M2006081

• Permit No: M2006081
• IBM Index Class Name: REPORT
• Doc Date: 6/27/2017
• Doc Name: Annual Fee/Report/Map
• From: David & Barbara Gaudreault
• To: DRMS
• Annual Report Year: 2016
• Email Name: ERR
• Media Type: D
• Archive: No

Page 5 of 5
Division records indicate the following pernlittee/lando-wrier contact information(blank fields indicate that we do not have
information on record). If this information is b-1 inkor not current,please type or print current contact information:
P_e_rmittee_Contact: Daniel J.Gaudreault
Permittec Company: Daniel J.Gaudreault and
Barbara.l. Gaudreault
Address: P.O. Box 69
Elizabeth,CO 80107
Phone Number: [phone]
--—-------
Fax Number: [phone]
Email Address: Danbarbg2(d�aol.com
Permitting Contact: Joe P.Gagliano
'9 0
Company: L.J. Development, Inc.
Address: 256 N Merrill Drive j>0 ��)c
Pueblo West,CO 81007 [c) c 01
Phone Number: [phone]
7 )
Fax Number: [phone]
Email Address:
Inspection Contact: Joe P. Gagliano
CompanN- L.J. Development, Inc.
Address: 256 N Merrill Drive LA
Pueblo West.CO 81007
Phone Number: [phone]
Fax Number: [phone]
Email Address: _YJ 10,
1,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 Dat"c
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