2015-08-10_REPORT - M2006010

• Permit No: M2006010
• IBM Index Class Name: REPORT
• Doc Date: 8/10/2015
• Doc Name: Annual Fee, Report and Map
• From: Las Animas County
• To: DRMS
• Email Name: AME
• 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:
Phil Dorenkamp
Permittee Company:
Las Animas County
Address:
2000 N. Linden Ave.
Trinidad, CO 81082
Phone Number:
[phone]
Fax Number:
Email Address:
[e-mail]
I, the undersi ed, hereby state that the information provided in this report is true and accurate, a d that site operations are
being cond ed in accordance with the Division approved mining and reclamation plans.
•
U/S-
Si2natureA
Permittee, Corporate Officer, Owner, or Documented Designee ate
M -AF -01