2017-06-29_M1994094_Annual Fee Notice ARCHIVE

• Permit No: M1994094A
• IBM Index Class Name: Report
• Doc Date: 6/29/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Boulder 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:

Ernst Strenge
Permittee Company:

Boulder County
Address:

5201 St Vrain Road
Longmont, CO 80503

Phone Number:

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

Paul Banks
Company:

Banks and Gesso, LLC
Address:

720 Kipling Street, Suite 117
Lakewood, CO 80215

Phone Number:

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

Dan Hershman
Company:

Boulder County
Address:

1288 Alaska Ave
Longmont, CO 80501

Phone Number:

[phone]
Fax Number: [phone]
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