2015-07-21_REPORT - M1993039

• Permit No: M1993039
• IBM Index Class Name: REPORT
• Doc Date: 7/21/2015
• Doc Name: Annual Fee, Report & Map
• From: City of Cripple Creek
• To: DRMS
• Email Name: TC1
• 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:
Steve DeCamillo
Permittee Company:
City of Cripple Creek
Address:
337 E. Bennett Ave.
P.O. Box 430
Cripple Creek, CO 80813
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 of Permittee, Corporate Officer, Owner, or Documented Designee Date
M -AF -04