2017-06-29_REPORT - M2009042

• Permit No: M2009042
• IBM Index Class Name: Report
• Doc Date: 6/29/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Montrose County
• Annual Report Year: 2017
• 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:

Steve White
Permittee Company:

Montrose County
Address:

949 N. 2nd Street
Montrose, CO 81401

Phone Number:

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

Ben Lagenfeld
Company:

Greg Lewicki & Associates
Address:

11541 Warrington Court
Parker, CO 80138

Phone Number:

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

Brian Wilson
Company:

Montrose County
Address:

161 South Townsend Avenue
Montrose, CO 81401

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