2015-04-28_REVISION - M2014045

• Permit No: M2014045
• IBM Index Class Name: REVISION
• Doc Date: 4/28/2015
• Doc Name: Designated Mining Limited Impact Operation Reclamation Permit Application Form CN01
• From: Mineral Mountain Gold, LLC
• To: DRMS
• Type & Sequence: CN1
• Email Name: TC1
• Email Name: WHE
• Media Type: D
• Archive: No

7. Couoncknce Information:
- APLICANT„- (OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: Lance Barker Title: President
Company Name: Mineral Mountain Gold, LL: C
Street/P.O. Box:
P.O. BU'x: 1071
City:
Cripple Creek
- -
State:
Colorado _.... ._.. _ - . _....- _ .. - - _
Zip Code. 8081$
Telephone Number.
Agency: Not Applicable
Fax Number:
Street:
PERMI 1NG CONTACT
(if different from appliCant/operator above)
State; -
Contact's Name:
Lance. Barker
Title: president
Company Name:
Mineral Mountain Gold, LW
Agency: Not Applicable
Street/PA Box:
P.O. Box: 247 _
City: Cripple Creek -
State: ColoradoZip Code: 80813'
Telephone Number: �7� 9 : ; -) _ 689-59$5
Fax Number:
INSPECTION CONTACT
Contacts Name: Lance Barker Title: President
Company Name: Mineral- Mountain Gold, LLC
Stre�'.O. Box: _ P.O. Box: 24T
City: %..Ieu�r.
State: Colorado
Zip Code: 80813
Telephone Number. 19 689 -5865
- -
Fax Number: ( -. _. - - _),... -
-
. STATE_ OR FEDERAL LANDO)"R (if any.)
Agency: Not Applicable
Street:
city: - -
State; -
Zip Code: _
Telephone Number.
CC: STATE OR FEDER_ AL LANDOWNER (if anyl
Agency: Not Applicable
Street:
City:
-
State:
Zip Code: -
Telephone Number: