2017-01-09_REPORT - M2007084

• Permit No: M2007084
• IBM Index Class Name: REPORT
• Doc Date: 1/9/2017
• Doc Name: Annual Fee/Report/Map
• From: Lincoln County
• To: DRMS
• Annual Report Year: 2017
• 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: _.Tolua. y4tt
Permittee Company: Lincoln County
Address: P.O.Box 39
Hugo,CO 80821
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: Beyft
e W C,�o&-4
Company: Lincoln County
Address: P.O.Box 39
Hugo, CO 80821
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact:
Company: Lincoln County
Address: P.O.Box 39
Hugo, CO 80821
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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Si a ;eofe,Corporate Officer Owner,or Documented Designee Date
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