2016-12-05_REPORT - M1980239

• Permit No: M1980239
• IBM Index Class Name: REPORT
• Doc Date: 12/5/2016
• Doc Name: Annual Fee/Report/Map
• From: Sweeney Pit No 30
• To: DRMS
• Email Name: ACY
• 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
Dan Miller
Permittee Company: Moffat County
Address: P.O. Box 667
Craig,CO 81626
Phone Number: [phone]
Fax Number: [phone]
Email Address:
[e-mail]
Permitting Contact: Billy E.Mack
Dan Miller
Company:
Moffat County Road & Bridge
Address: P.O. Box 667
Craig, CO 81626
Phone Number: [phone]
[phone] Ext 1015
Fax Number: [phone]
Email Address:
[e-mail]
Inspection Contact: Dennis Jones
Dan Miller
Company: Moffat County
Address: P.O.Box 667
Craig,CO 81626
Phone Number: [phone]
Fax Number:
[phone]
Email Address:
[e-mail]
1,the undersigned,hereby state that the information provided in this report is true and accurate,and that site operations are
being Vndudin accordance with the Division approved mining and reclamation plans.
�� Dan Miller- Director 11/23/2016
Signature of Permittee, Corporate Officer,Owner,or Documented Designee Date
M-AF-04