2016-12-06_REPORT - M1992113

• Permit No: M1992113
• IBM Index Class Name: REPORT
• Doc Date: 12/6/2016
• Doc Name: Annual Fee/Report/Map
• From: Verhoeff Pit No 2
• 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: Calvin Feik
Permittee Company: Bent County
Address: P.O. Box 350
Las Animas, CO 81054-0350
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: -C�telrnrd-
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Company: Bent County
Address: P.O. Box 350
Las Animas, CO 81054-0350
Phone Number: [phone]
Fax Number: [phone]
Email Address: ,
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Inspection Contact: Curtis Sniff
Company: Bent County
Address: P.O. Box 350
Las Animas, CO 81054-0350
Phone Number: w 9_82 y_ Y770
Fax Number: [phone]
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.
Signature of Permittee, Corporate Officer,Owner,or Documented Designee Date
M-AF-04