2021-01-08_REVISION - M1977410

• Permit No: M1977410
• IBM Index Class Name: Revision
• Doc Date: 1/8/2021
• Doc Name: Request For Amendment To Permit
• From: Grand Island Resources LLC
• To: DRMS
• Type & Sequence: AM2
• Email Name: AME
• Email Name: MAC
• Email Name: AWA
• Media Type: D
• Archive: No

-2-
Correspondence Information:
APPLICANT/OPERATOR (name,address,and phone of name to be used on permit):
Contact's Name: Alfred F. Gerriets II Title: CEO
Company Name: Grand Island Resources, LLC
Street: 65 Arikaree Cir. P.O. Box: 3395
City: Nederland
State- CO Zip Code: 80466
Telephone Number- (212 ) _ 920-1941
Fax Number: -
PERMITI'ING CONTACT (if different from applicant/operator above):
Contact's Name: Richard Mittasch Title: VP of Operations
Company Name: Grand Island Resources, LLC
Street: 34 Mitchell Ave P.O.Box:
City: Plainview
State: NY Zip Code: 11803
Telephone Number- 516 1 _ 582-0833
Fax Number. � ) -
INSPECTION CONTACT:
Contact's Name: Daniel V. Pollock Title: Director of Regulations and Permitting
Company Name: Grand Island Resources, LLC
Street: 300 Spruce Way P.O.Box: 0441
Citv: Nederland
State: CO Zip Code. 80466
Telephone Number: 720 ) _ 207-5154
Fax Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER(if any):
Agency:
Street:
City:
State: Zip Code:
Telephone Number: ( ) -
�C: STATE OR FEDERAL LANDOWNER(if any
Agency:
Street:
City:
State. "Zip Code:
Telephone Number r ) -