2016-11-18_REPORT - M2005065

• Permit No: M2005065
• IBM Index Class Name: Report
• Doc Date: 11/18/2016
• Doc Name: Annual Fee/Report/Map
• From: Upper Animas Sand and Gravel Pit
• To: DRMS
• Annual Report Year: 2015
• Email Name: LJW
• 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: Jack Clark Jr
Permittee Company. Jack Clark,Jr.
Address: P. O. Box 767
Silverton,CO 81433
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Charles R.Ponchak
Company: Charles R.Ponchak
Address: 15292 6050 Rd.
Montrose,CO 81401
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Jack Clark Jr
Company: Jack Clark Jr.
Address: P.O.Box 767
Silverton, CO 81433
Phone Number: [phone]
Fax Number:
Email Address:
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
Signature of 260ttee,Cor orate Officer er.or Documented Designee Date
M-AF-01