2017-11-20_REPORT - M1982015

• Permit No: M1982015
• IBM Index Class Name: REPORT
• Doc Date: 11/20/2017
• Doc Name: Annual Fee/Report/Map
• From: Carma Bayshore LLC dba Bayshore, LLC
• To: DRMS
• Annual Report Year: 2017
• Email Name: PSH
• Media Type: D
• Archive: No

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: Marc Savela
Permittee Company: Carma Bayshore LLC dba
Bayshore, LLC 17/<- .(''l7 6 C C'-
Address: 6465 S. Greenwood Plaza Blvd.,
Ste. 700
Centennial,CO 80111
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: Marc Savela
Company: Carma Bayshore LLC dba M/ f=�� ,-
Bayshore, LLC
Address: 6465 S. Greenwood Plaza Blvd.,
Ste. 700
Centennial,CO 80111
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Inspection Contact: Marc Savela
Company: Carma Bayshore LLC dba
Bayshore,LLCLC.-- 0--
Address: 6465 S. Greenwood Plaza Blvd.,
Ste. 700
Centennial,CO 80111
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
I,the undersigned, hereby state that the information pro '. d in this report is true and accurate, and that site operations are
being conducted in accordance with the D —on ap; I -2 mining and reclamation plans.
///,/,
Signature of Permittee,C r orate O er,Owner,or Documented Designee gu � ee Date
M-AF-01