2017-09-22_REPORT - M2005080

• Permit No: M2005080
• IBM Index Class Name: REPORT
• Doc Date: 9/22/2017
• Doc Name: Annual Fee/Report/Map
• From: Allen Drilling and Excavating
• To: DRMS
• Annual Report Year: 2017
• Email Name: MAC
• 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: Jack Allen
Permittee Company: Allen Drilling and Excavating
Address: 651 Hwy 285
P.O. Box 398
Fairplay, CO 80440
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Angela Bellantoni
Company: Environmental Alternatives, Inc.
Address: 402 Valley Rd Ste 10
Canon City, CO 81212-4176
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Jack Allen
Company: Allen Drilling and Excavating
Address: 651 Hwy 285
P.O. Box 398
Fairplay,CO 80440
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
1,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.
Signatu� ermittee,CorA ate Officer,Owner,or Documented Designee Date
M-AF I