2017-02-21_M1979058_Annual Fee Notice ARCHIVE

• Permit No: M1979058A
• IBM Index Class Name: Report
• Doc Date: 2/21/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Routt County
• Annual Report Year: 2017
• Media Type: D
• Archive: Yes

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:

Michael T. Mordi
Permittee Company:

Routt County
Address:

P.O. Box 773598
Steamboat Springs, CO 80477

Phone Number:

[phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact:

Paul H. Draper
Company:

Routt County
Address:

P.O. Box 773598
136 6th St.
Steamboat Springs, CO 80477

Phone Number:

[phone]
Fax Number: [phone]
Email Address:
Inspection Contact:

William Rogers
Company:

Routt County
Address:

P.O. Box 773598
136 6th St.
Steamboat Springs, CO 80477

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.

Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date

M-AF-04