2017-02-14_REPORT - M2010083

• Permit No: M2010083
• IBM Index Class Name: REPORT
• Doc Date: 2/14/2017
• Doc Name: Annual Fee/Report/Map
• From: Lincoln County
• To: DRMS
• Annual Report Year: 2017
• Email Name: TC1
• Media Type: D
• Archive: No

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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: ..Jokft r4eW44
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Permittee Company: Lincoln County
Address: P.O.Box 39
Hugo,CO 80821
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: —ohnZeMAW i'—j"c f�
Company: Lincoln County
Address: P.O. Box 39
Hugo,CO 80821
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: 3ektrBeVAq
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Company: Lincoln County
Address: P.O. Box 39
Hugo,CO 80821
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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Signatyr-e' e e or orate Officer,Owner,or Documented Designee Date
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