2015-11-02_REPORT - P2014013

• Permit No: P2014013
• IBM Index Class Name: Report
• Doc Date: 11/2/2015
• From: DRMS
• To: Operator
• Annual Report Year: 2015
• Media Type: D
• Archive: No

Page 6 of 6

Division records indicate the following permittee/landowner contact information. If this information is not current, please
type or print current contact information: Rule 5.6.1(a, b).

Permittee Contact:

Adam Sotomayer
Permittee Company:

Smash Brothers Explorations
Address:

P.O. Box 73

Divide, CO 80814

Phone Number:

[phone]
Fax Number:
Email Address:

Landowner Contact:

Landowner Address:

Landowner Phone
Number:

Landowner Email

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 NOI and reclamation plans. Rule 5.6.1(h).

Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date

P-AF-01