2016-07-20_REPORT - M1986079

• Permit No: M1986079
• IBM Index Class Name: Report
• Doc Date: 7/20/2016
• Doc Name: Annual Fee/Report/Map
• From: M & G Pit
• To: DRMS
• Annual Report Year: 2016
• Email Name: TOD
• Media Type: D
• Archive: No

Page 5 of 5
Division records indicate the following pennittee contact information. If this information is not current,please type or print
current contact information:
Permittee Contact: Clay Carlson
Permittee Company: Mann Resources LLC
Address: P.O. Box 247
Eastlake,CO 80614
Phone Number: [phone]
Fax Number:
Email Address:
1,the undersigned,her a that the information provided in this report is true and accurate,and that site operations are
in
being conducted _o-rda-n-c with the D* ''i'on approved mining and reclamation plans.
q/1
Signature of Permittee, ra—WOtricer.owner,orlocumented Designee to
M-AF-01