2017-01-30_REPORT - M1977153

• Permit No: M1977153
• IBM Index Class Name: REPORT
• Doc Date: 1/30/2017
• Doc Name: Annual Fee/Report/Map
• From: Denver Water Department
• To: DRMS
• Annual Report Year: 2017
• Email Name: JLE
• 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: Ryan P. Stitt
Permittee Company: Denver Water Department
Address: 1600 W. 12th Avenue
Mail Code 413
Denver,CO 80204
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Michael L. Walker
Company: Denver Water Department
Address: 1600 W. 12th Ave.
Denver,CO 80204
Phone Number: [phone]
Fax Number: [phone]
(303) (028 — �852
Email Address:
Inspection Contact: Michael L. Walker
Company: Denver Water Department
Address: 1600 W. 12th Ave.
Denver,CO 80204
Phone Number: [phone]
Fax Number: [phone]
Email Address: l - 4 1 1 q
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.
(Zvn��� I 19—C) of
Si ur of ftrUittee,Corporate Officer,Owner,or Documented Designee date
M-AF-04