2017-02-01_REPORT - M1979142

• Permit No: M1979142
• IBM Index Class Name: REPORT
• Doc Date: 2/1/2017
• Doc Name: Annual Fee/Report/Map
• From: CDOT
• To: DRMS
• Annual Report Year: 2017
• 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:
Permittee Contact: Dennis Sanchez
Permittee Company: Colorado Department of
Transportation
Address: 260 Ranney Street
Craig,CO 81625
Phone Number: [phone]
q1c - 1st,14 Ca. )
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Dennis Sanchez
Company: Colorado Department of
Transportation
Address: 260 Ranney Street
Craig, CO 81625
Phone Number: 970 824-5104
Fax Number: [phone]
Email Address: [e-mail]
Inspection Contact: Dennis Sanchez
Company: Colorado Department of
Transportation
Address: 260 Ranney Street
Craig, CO 81625
Phone Number: [phone]
rT'
Fax Number: [phone]
Email Address: [e-mail]
I,t undersigned,hereby state that the information provided in this report is true and accurate,and that site operations are
bein conducted in accord ce with the Division approved mining and reclamation plans.
�3C)
Signature of Permittee,Corporate Of icer,Owner,or Documented Designee Date
M-AF-04