2015-07-06_REPORT - M1977459

• Permit No: M1977459
• IBM Index Class Name: REPORT
• Doc Date: 7/6/2015
• From: Lake County
• To: DRMS
• Annual Report Year: 2015
• Email Name: DMC
• 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:
BradPalmer
Permittee Company:
Lake County
Address:
P.O. Box 952
Leadville, CO80461
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 conducteo'i%agQordance with the Division approved mining and reclamation plans.
6— Js'
Owner, or Documented Designee Date
M -AF -O4