2017-02-08_REPORT - M2008025

• Permit No: M2008025
• IBM Index Class Name: REPORT
• Doc Date: 2/8/2017
• Doc Name: Annual Fee/Report/Map
• From: Tim Kunau
• To: DRMS
• Annual Report Year: 2017
• Email Name: TC1
• 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: Tim Kunau
Permittee Company: Tim Kunau
Address: 23945 Lucky Ln
Calhan, CO 80808
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: Tim Kunau !/
Company: Tim Kunau
Address: 23945 Lucky Lane
Calhan, CO 80808
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: Tim Kunau
Company: Tim Kunau
Address: 23945 Lucky Lane
Calhan,CO 80808
Phone Number: [phone]
Fax Number:
Email Address:
1,the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are
being con u in accordance with the Division approved mining and reclamation plans.
1-24 -17
Signa re of Per -ittee,Co Borate Officer,Owner,or Documented Desienee Date
M-AF-01