2016-06-14_REPORT - M2005006

• Permit No: M2005006
• IBM Index Class Name: REPORT
• Doc Date: 6/14/2016
• Doc Name: Annual Fee/Report/Map
• From: Powderwash Pit No. 66
• To: DRMS
• Annual Report Year: 2016
• Email Name: ACY
• 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: Billy E.Mack
Permittee Company: Moffat County
Address: P.O.Box 667
Craig,CO 81626
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
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.
�lh 10— .Q_ � —�— l /1 - /
gn ture L to
of Permittee,Corporate Officer,Owner, r Documented Designee Date
M-AF-04
1
•