2017-06-30_REPORT - M2006075

• Permit No: M2006075
• IBM Index Class Name: REPORT
• Doc Date: 6/30/2017
• Doc Name: Annual Fee/Report/Map
• From: Granby Realty
• To: DRMS
• Annual Report Year: 2016
• Email Name: PSH
• Media Type: D
• Archive: No

Page S of S
Division records indicate the following permittee/landowner contact information(blank fields indicate that we do not have
information on record). Tfthis information 1s blank or not current,please type or print Curren contact information:
Perrnittee Contact: bfineeBadw Current Permitte Contact:
Melissa Cipriani
Permittee Company: Granby Realty Holdings,LLC
Address: P.O.Box 1110
Granby,CO 80446
4
Phone Number: -(970)Bw 5295 [phone]
Fax Number: (970)88-7-9623
Email Address: [e-mail]
Perml#thig Contact. Paul Banks
Company: Banks and Gesso,LLC
Address: 720 Kipling Street,Suite 117
Lakewood,CO 80215
Phone Number: [phone]
Fox Number: [phone]
Email Address:
Inspection Contact: RiehtkM Migehelbrink Current Inspection Contact:
Lance Badger
Company: Granby Realty Holdings,LLC
Address: 999 VillegeRoad
Gnuiby,CO 80446
Phone Number: ( ) - [phone]
FaxNumben (970)328 21 l3
Email Address: [e-mail]
1,the undmigned,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 paining and reelamntion plans.
8lgnatt ro of ernr ttee orate OfAcer.,QURLr,or Documented Deslenee Date
M-AP.OF