2017-07-26_M1982131_Annual Fee Notice ARCHIVE

• Permit No: M1982131A
• IBM Index Class Name: Report
• Doc Date: 7/26/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Bucklen Equipment Company, Inc.
• 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:

Mike Bucklen
Permittee Company:

Bucklen Equipment Company,
Inc.

Address:

804 N 25th Ave
Greeley, CO 80631

Phone Number:

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

Carrie Herbolsheimer
Company:

Applegate Group, Inc.
Address:

1490 W. 121st Ave., Ste. 100
Denver, CO 80234

Phone Number:

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

Judy May
Company:

Bucklen Equipment Company,
Inc.

Address:

804 N 25th Ave
Greeley, CO 80631

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-01