2016-01-15_REPORT - M1980249 ‎(2)‎

• Permit No: M1980249
• IBM Index Class Name: Report
• Doc Date: 1/15/2016
• Doc Name: Annual Fee, Report and Map
• From: Charles W. Houchin
• To: DRMS
• Annual Report Year: 2016
• 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:
Curt Houchin
Permittee Company:
Charles W Houchin
Address:
P.O. Box 85
Green Mountain Falls, CO
80819
Phone Number:
[phone]
•
Fax Number:
Email Address:
[e-mail]
I, the undersigned, hereby s . t' at thysrmation provided in this report is true and accurate, and that site operations are
being conducted in acc
roved g and reclamation plans.
r, or 1 ocumented Designee Date