2015-10-27_REPORT - M2010071

• Permit No: M2010071
• IBM Index Class Name: REPORT
• Doc Date: 10/27/2015
• From: The City of Lafayette
• To: DRMS
• Annual Report Year: 2015
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

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Division records indicate the following permittee contact information. Willis information is not current, please type or print
currcnt contact information:
Permittee Contact: Bradley Dallam
Permittee Company: The City of Lafayette
Address:
1290 South Public Road
Lafayette, CO 80026-2706
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.
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Signature of ' ermittee, or Officer, Owner, or Documented Desienee Da
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