2017-02-03_REPORT - M1976056

• Permit No: M1976056
• IBM Index Class Name: REPORT
• Doc Date: 2/3/2017
• Doc Name: Annual Fee/Report/Map
• From: McAtee Construction
• To: DRMS
• Annual Report Year: 2017
• Email Name: JLE
• Media Type: D
• Archive: No

Pagc 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: Darren Gebhart
Permittee Company: McAtee Construction Company
Address: P.O. Box 1908
Sterling,CO 80751
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Darren Gebhart
Company: McAtee Construction Co.
Address: P.O. Box 1908
Sterling,CO 80751
Phone Number: [phone]
Fax Number: [phone]
Email Address:
[e-mail]
Inspection Contact: Darren Gebhart
Company: McAtee Construction Co.
Address: P.O. Box 1908
Sterling,CO 80751
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
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.
1-31-17
Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date
NI-AF-01