2016-11-22_REPORT - M1979111

• Permit No: M1979111
• IBM Index Class Name: REPORT
• Doc Date: 11/22/2016
• Doc Name: Annual Fee/Report/Map
• From: Enderson Pit
• To: DRMS
• Annual Report Year: 2016
• Email Name: AME
• 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: 4vtm-BeWitt-"
Permittee Company: Lincoln County
Address: P.O. Box 39
Hugo, CO 80821
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Permitting Contact: -30inrB
Company: Lincoln County
Address: 103 3rd Avenue
Hugo, CO 80821
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: f
-ZI-eff CIO
Uh
Company: Lincoln County
Address: 103 3rd Avenue
Hugo, CO 80821
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.
7
Signat of ee Corporate Officer,Owner,or Documented Designee Date
M-AF-04