2015-09-01_REPORT - M2013056

• Permit No: M2013056
• IBM Index Class Name: REPORT
• Doc Date: 9/1/2015
• Doc Name: Annual Fee, Report & Map
• From: Richard Fretterd
• 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:
Richard Fretterd
Permittee Company:
Richard Fretterd
Address:
1065 Woodland Ave, #16
Woodland Park, CO 80863
Phone Number:
[phone]
Fax Number:
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
M -AF -02
Owner, or Documented Designee Date