2017-02-24_REPORT - M1978268

• Permit No: M1978268
• IBM Index Class Name: REPORT
• Doc Date: 2/24/2017
• Doc Name: Annual Fee/Report/Map
• From: Ouray County
• 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: Chris Miller � � ins
Permittee Company: Ouray County
Address: P.O. Box 456
Ridgway, CO 81432
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Douglas Conger
Company: Geological Services
Address: 711 Hartman Rd.
Cortez, CO 81321
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Bob Wolford 5' e1 i ns
Company: Ouray County Road&Bridge
Department
Address: P.O. Box 456
Ridgway, CO 81432-0456
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 e Division approved mining and reclamation plans.
Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-04