2015-06-23_REPORT - M2004017

• Permit No: M2004017
• IBM Index Class Name: REPORT
• Doc Date: 6/23/2015
• Doc Name: Annual Fee, Report and Map
• From: Willits Company, Inc.
• To: DRMS
• Email Name: PSH
• 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:
BobWillits
Permittee Company:
Willits Company, Inc.
Address:
P.O. Box 825
Cheyenne, WY82003
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 accor*nce with the Division approved mining and reclamation plans.
Signature
M -AF -04
1511
Owner, or Documented Designee Date