2017-02-09_REPORT - M1977227

• Permit No: M1977227
• IBM Index Class Name: Report
• Doc Date: 2/9/2017
• Doc Name: Annual Fee/Report/Map
• From: Super Ex., LLC
• To: DRMS
• Annual Report Year: 2017
• Email Name: LJW
• Media Type: D
• Archive: No

Division records indic tte the fitllowing pern►iltc,e/landowner contact information(blank fields indicate that we doer of ors
infi►rmaticm on rcco►d'. If this inli►rmation is blank or not current, please type or print current contact information:
Permittee Contact:
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Permittee Con►pan)':
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Address:
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Phone Number: _
t'ax Number:
Finail Address:
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Permitting Contact,
Company:
Address:
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Phone Number: -
Fax Number:
kinail Address:
Inspection Contact:
Company.
Address:
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Email Address: __ ---,_--
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the undersigned, here)) ti Ate, that the information provided in this report is true and accurate,and that site operations are
being conducted in ►ecc rc.nue with the Division approved mining and reclamation plans.
gnature of Permittee►�_oruorate Officer,Owncr,or 1)ocumcnted DesiLnce
,,:_„f Date