2017-02-14_REPORT - M2002017

• Permit No: M2002017
• 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

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: a rtt
UP-�'C a
Permittee Company: Lincoln County
Address: P.O. Box 39
Hugo, CO 80821
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: 1e1;4-B��-t n L) ✓U� `
Company: Lincoln County `�S
Address: P.O. Box 39
Hugo,CO 80821
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: -3ohn-He /
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.
:S*C?a e f rmi ee Cor orate Officer,Owner,or Documented Designee Date