2016-12-20_REPORT - M1979158

• Permit No: M1979158
• IBM Index Class Name: REPORT
• Doc Date: 12/20/2016
• Doc Name: Annual Fee/Report/Map
• From: Colorado City Metropolitan District
• To: DRMS
• Annual Report Year: 2016
• Email Name: ERR
• Media Type: D
• Archive: No

Page 5 of 5
Division records indicate the following pennittee/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: David Valdez
Permittee Company: Colorado City Metropolitan
District
Address: 4497 Bent Brothers Blvd.
P.O.Box 20229
Colorado City,CO 81019
Phone Number: [phone]
3
Fax Number: [phone]
Email Address:
rnana �rc� I h Val p y.n�t
Permitting Contact: David Valdez
Company: Colorado City Metropolitan
District
Address: 4497 Bent Brothers Blvd.
P.O.Box 20229
Colorado City,CO 81019
Phone Number: [phone]
Fax Number: [phone]
Email Address:
loc,a rnana Pr e h Ja II py, lef
Inspection Contact: David Valdez
Company: Colorado City Metropolitan
District
Address: 4497 Bent Brothers Blvd.
P.O.Box 20229
Colorado City,CO 81019
Phone Number: [phone]
Fax Number: [phone]
[Ema"dress:
1,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 P "-�—LI La
L/1�J 6
Signature of Permittee Cor or er.Owner,or Documented Designee Date
M At-04