2006-09-01_REPORT - M2004042

• Permit No: M2004042
• IBM Index Class Name: REPORT
• Doc Date: 9/1/2006
• Doc Name: Annual Fee/Report/Map
• From: Ralph Porco, Randy Porco
• To: DRMS
• Annual Report Year: 2016
• Email Name: DMC
• 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:
lPermittee Contact: Ralph Porco
Permittee Company: Ralph Porco, Randy Porco
Address: 11150 FDR 255
La Jara, CO 81140
Phone Number: [phone]
Fax Number:
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.
I po�� O :
Signature o ermittee, Corporate Officer,Owner,or Documented Designee Date
M-AF-01