2017-09-29_M2011026_Annual Fee Notice ARCHIVE

• Permit No: M2011026A
• IBM Index Class Name: Report
• Doc Date: 9/29/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Keyah Grande Lodge and Elk Ranch
• 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:

Michael Iguchi
Permittee Company:

Keyah Grande Lodge and Elk
Ranch

Address:

13211 Highway 160 West
Pagosa Springs, CO 81147

Phone Number:

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

Clinton Casey
Company:

SME Environmental
Address:

555 Rivergate Lane BI-101
Durango, CO 81301

Phone Number:

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

Company:

Address:

Phone Number:

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