2015-06-19_REPORT - M2012008

• Permit No: M2012008
• IBM Index Class Name: REPORT
• Doc Date: 6/19/2015
• Doc Name: Report
• From: City of Las Animas
• To: DRMS
• Email Name: AME
• Media Type: D
• Archive: No

Page 5 of 5
Division records indicate the following permittee contact information. If this information is not current, please type or
print current contact information:
Permittee Contact:
KenWagner
Permittee Company:
City of Las Animas
Address:
532 Carson Avenue
P.O. Box 468
Las Animas, CO81054
Phone Number:
[phone]
Fax Number:
[phone]
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.
Signature ofPermittee, Corporate Officer, Owner, or Documented Designee
M -AF -04
Date