2017-09-29_M2002087_Annual Fee Notice ARCHIVE

• Permit No: M2002087A
• IBM Index Class Name: Report
• Doc Date: 9/29/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Mask Ranch, 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:

Roger August
Permittee Company:

Mask Ranch, LLC
Address:

P.O. Box 5356
Pagosa Springs, CO 81147

Phone Number:

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

Timothy M. Scanlon
Company:

TMS Consulting
Address:

P.O. Box 53
Saguache, CO 81149

Phone Number:

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

Roger August
Company:

Mask Ranch, LLC
Address:

P.O. Box 5356
Pagosa Springs, CO 81147

Phone Number:

[phone]
Fax Number: [phone]
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