2017-02-20_REPORT - M2011017

• Permit No: M2011017
• IBM Index Class Name: Report
• Doc Date: 2/20/2017
• Doc Name: Annual Fee/Report/Map
• From: Breeze Basin Resources
• To: DRMS
• Annual Report Year: 2017
• Email Name: ACY
• Media Type: D
• Archive: No

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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:
Rick Damson
Permittee Company:
Breeze Basin Resources
Address:
PO Box 181
Hayden, CO 81639
Phone Number:
[phone]
Fax Number:
[phone]
Email Address:
Permitting Contact:
Company:
Address:
Phone Number:
Fax Number:
Email Address:
Inspection Contact:
Rick Domson
Company:
Breeze Basin Resources
Address:
PO Box 181
Hayden, CO 81639
Phone Number:
[phone]
Fax Number:
[phone]
Email Address:
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.
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Signature of Permittee. Coraorate Officer, Owner, or Documented Designee Date
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