2015-07-20_REPORT - M1981085

• Permit No: M1981085
• IBM Index Class Name: REPORT
• Doc Date: 7/20/2015
• From: N Colo Water Conservancy Dist
• To: DRMS
• Annual Report Year: 2015
• Permit Index Doc Type: Annual Fee/Report
• 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:
JimStruble
Permittee Company:
N Colo Water Conservancy Dist.
Address:
220 Water Avenue
Berthoud, CO80513
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.
cer, Owner, or Documented Desitnee Date
M -AF -04