2017-08-30_REPORT - M2013068

• Permit No: M2013068
• IBM Index Class Name: Report
• Doc Date: 8/30/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Colorado Rose Red Inc.
• 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:

Caleb Liesveld
Permittee Company:

Colorado Rose Red Inc.
Address:

148 Cheyenne Ct.
Lyons, CO 80540

Phone Number:

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

Steve O’Brian
Company:

Environment, Inc.
Address:

7985 Vance Dr., #205A
Arvada, CO 80003

Phone Number:

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

Caleb Liesveld
Company:

Colorado Rose Red Inc.
Address:

148 Cheyenne Ct.
Lyons, CO 80540

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-01