2017-09-29_M2008060_Annual Fee Notice ARCHIVE

• Permit No: M2008060A
• IBM Index Class Name: Report
• Doc Date: 9/29/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: CLG Farms, LLC
• 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:

Chester W. Gebauer
Permittee Company:

CLG Farms, LLC
Address:

37951 Highway 34
Otis, CO 80743

Phone Number:

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

Kelly S. Hansen
Company:

Hansen Law LLC
Address:

117 Main Avenue
P.O. Box 400
Akron, CO 80720

Phone Number:

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

Chester W. Gebauer
Company:

CLG Farms, LLC
Address:

37951 Highway 34
Otis, CO 80743

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