2017-02-23_REPORT - M2011034

• Permit No: M2011034
• IBM Index Class Name: REPORT
• Doc Date: 2/23/2017
• Doc Name: Annual Fee/Report/Map
• From: Cooley and Sons Excavating
• To: DRMS
• Annual Report Year: 2017
• Email Name: THM
• 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: James Cooley
Permittee Company: Cooley& Sons Excavating,Inc.
Address: 4469 County Rd 108
Mosca, CO 81146
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: James Cooley
Company: Cooley&Sons Excavating, Inc.
Address: 4469 N. CR. 108
Mosca,CO 81146
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: James Cooley
Company: Cooley&Sons Excavating,Inc.
Address: 4469 CR 108
Mosca, CO 81146
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.
-�,
Sig�t7of Permittee Cor orate Off' r,Owner,or Documented Designee Date
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