2017-02-23_REPORT - M1977081

• Permit No: M1977081
• IBM Index Class Name: REPORT
• Doc Date: 2/23/2017
• Doc Name: Annual Fee/Report/Map
• From: Pueblo County
• To: DRMS
• Annual Report Year: 2017
• Email Name: ERR
• 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: Patricia K. Coffee
Permittee Company: Pueblo County
Address: 33601 United Ave
Pueblo, CO 81001
Phone Number: [phone]
Fax Number: [phone]
Email Address: zpa��o. C�''�Dt�'b)o c-'t��l/� ��
Permitting Contact:
Company: Pueblo County
Address: 33601 United Ave ,
Pueblo,CO 81001-4895
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Patricia Coffee
Company: Pueblo County
Address: 33601 United Ave
Pueblo,CO 81001-4895
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail] �ajCO (--0�
1,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.
a /7
Signa a of Permittee.-4torporate Officer,Owner,or Documented Designee Date
M-AF-04