2017-10-03_REPORT - M1990106

• Permit No: M1990106
• IBM Index Class Name: REPORT
• Doc Date: 10/3/2017
• Doc Name: Annual Fee/Report/Map
• From: RBK Construction, Inc
• To: DRMS
• Annual Report Year: 2017
• Email Name: ERR
• Media Type: D
• Archive: No

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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: Ronda Neumeister
Permittee Company: RBK Construction, Inc.
Address: P.O. Box 387
Rye, CO 81069
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: Pates nn
ILO N DA hlr'L,jilcr57-C-
Company: RBK Construction, Inc.
Address: P.O. Box 387
Rye, CO 81069
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: Pat kk-c�tty
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Company: RBK Construction,Inc.
Address: P.O. Box 387
Rye, CO 81069
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.
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Signature of Permittee Cor to Officer,Owner,or Documented Designee Date
M-AF-01