2016-12-12_REPORT - M2009079

• Permit No: M2009079
• IBM Index Class Name: REPORT
• Doc Date: 12/12/2016
• Doc Name: Annual Fee/Report/Map
• From: Precision Excavating
• To: DRMS
• Annual Report Year: 2016
• 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:
Permitee Contact: David S.Zehner
Penn ittee Company: Precision Excavating, Inc.
Address: P.O. Box 790
Hayden, CO 81639
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: David S.Zehner
Company: Precision Excavating, Inc.
Address: 195 W. Jefferson
Hayden, CO 81639
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: David S.Zehner
Company: Precision Excavating, Inc.
Address: 195 W. Jefferson
Hayden, CO 81639
Phone Number: [phone]
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.
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Signature of Permitee C r orate Officer,Owner,or Documented Designee Date
M-AF-01