2016-11-16_REPORT - M2006076

• Permit No: M2006076
• IBM Index Class Name: Report
• Doc Date: 11/16/2016
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Moffat County
• Annual Report Year: 2017
• Media Type: D
• Archive: No

Page 5 of 5

Division records indicate the following permittee/landowner contact information (blank fields indicate that we do not have
information on record). If this information is blank or 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:
Email Address: [e-mail]
Permitting Contact:

Marvin Moore
Company:

Address:

1570 Ranney Street
Craig, CO 81625

Phone Number:

[phone]
Fax Number:
Email Address:
Inspection Contact:

Billy Mack
Company:

Moffat County Road Department
Address:

822 E. 1st St.
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.

Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date

M-AF-04