2017-06-29_REPORT - M2016033

• Permit No: M2016033
• IBM Index Class Name: Report
• Doc Date: 6/29/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Van Valkenburg Cattle Company, LLC
• 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:

William Van Valkenburg
Permittee Company:

Van Valkenburg Cattle
Company, LLC

Address:

12353 Hwy 14
Walden, CO 80480

Phone Number:

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

Kent Holsinger
Company:

Holsinger Law, LLC
Address:

1800 Glenarm Place, Suite 500
Denver, CO 80202

Phone Number:

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

William Van Valkenburg
Company:

Van Valkenburg Cattle
Company, LLC

Address:

12353 Hwy 14
Walden, CO 80480

Phone Number:

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

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-01