2017-06-29_M1995026_Annual Fee Notice ARCHIVE

• Permit No: M1995026A
• IBM Index Class Name: Report
• Doc Date: 6/29/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Custer 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:

Rusty Christensen
Permittee Company:

Custer County
Address:

P.O. Box 1669
Westcliffe, CO 81252

Phone Number:

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

Abel Tapia
Company:

Abel Engineering Professionals
Address:

807 N Greenwood
Pueblo, CO 81003

Phone Number:

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

Rick Perschbacher
Company:

Custer County Road and Bridge
Address:

P.O. Box 1669
Westcliffe, CO 81275

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-04