2017-09-29_M2009074_Annual Fee Notice ARCHIVE

• Permit No: M2009074A
• IBM Index Class Name: Report
• Doc Date: 9/29/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Colorado Backhoe Service
• 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:

Thomas Joseph
Permittee Company:

Colorado Backhoe Service
Address:

25193 South Road
Pueblo, CO 81006

Phone Number:

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

Stevan L. O’Brian (Steve)
Company:

Environment, Inc.
Address:

7985 Vance Dr Ste 205A
Arvada, CO 80003

Phone Number:

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

Thomas Joseph
Company:

Colorado Backhoe Service
Address:

25193 South Road
Pueblo, CO 81006

Phone Number:

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

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