2017-08-30_M2010071_Annual Fee Notice ARCHIVE

• Permit No: M2010071A
• IBM Index Class Name: Report
• Doc Date: 8/30/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: The City of Lafayette
• 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:

Bradley Dallam
Permittee Company:

The City of Lafayette
Address:

1290 South Public Road
Lafayette, CO 80026-2706

Phone Number:

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

Aaron Asquith
Company:

McLaughlin Water Engineers,
Ltd.

Address:

2420 Alcott Street
Denver, CO 80211

Phone Number:

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

Aaron Asquith
Company:

McLaughlin Water Engineers,
Ltd.

Address:

2420 Alcott Street
Denver, CO 80211

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