2017-11-20_REPORT - M1982015 ‎(2)‎

• 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: 2016
• 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 >/'_-aCel-'y
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 —� T
Bayshore,LLC r7/M- '1>C% e_- 6_-,�
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: Carina Bayshore LLC dba
Bayshore,LLC T V ci' i L G
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 provide in 1 is report is true and accurate,and that site operations are
being conducted in accordance with the Divisio .'•rove,. mini g and reclamation plans.
/
VI 6//-
Signature of Permittee, rpo at I ''cer,Owner,o i ocumented Designee cis ate
M-AF-01