2017-02-28_REPORT - M2010075

• Permit No: M2010075
• IBM Index Class Name: REPORT
• Doc Date: 2/28/2017
• Doc Name: Annual Fee/Report/Map
• From: Washington County
• To: DRMS
• Annual Report Year: 2017
• Email Name: ECS
• 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: Steve Williams
Permittee Company: Washington County
Address: 150 Ash Avenue
Akron, CO 80720
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Randy Schafer
Company: Randy Schafer
Address: 40586 Co. Rd. 21
Haxtun,CO 80731
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Steve Williams
Company: Washington County Road and Bridge
Department
Address: 11920 Co.Rd. CC
PO Box 32
Anton, CO 80801
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.
Signs ure of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-04