2017-03-06_REPORT - M1989116

• Permit No: M1989116
• IBM Index Class Name: REPORT
• Doc Date: 3/6/2017
• Doc Name: Annual Fee/Report/Map
• From: City of Colorado Springs
• To: DRMS
• Email Name: TC1
• 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: Dave D.Jordan
Kelly Thompson
Permittee Company: City of Colorado Springs
Address: P.O.Box 1575
Mail Code 060
Colorado Springs, CO 80901-
1575
Phone Number: [phone] [phone]
Fax Number: [phone]
[phone]
Email Address: kthonlpsonCwspringsgov.com
Permitt' Contact: Preston Kimler
Jack Glavan
Company: City of Colorado Springs
Address: P.O. Box 1575
MC 451 PO Box 1575, MC 060
Colorado Springs, CO 80901- Colorado Springs, CO 80901-1575
1575
Phone Number: [phone] [phone]
Fax Number:
[phone]
Email Address: jglavan(7)springsgov.coni
Inspection Contact: Preston Kimler Kelly'I'll o nipso 11
Company: City of Colorado Springs
Address: P.O. Box 1575
MC 451 PO Box 1575, MC 060
Colorado Springs, CO 80901- Colorado Springs, CO 80901-1575
1575 _
Phone Number: [phone]
[phone]
Fax Number:
[phone]
Email Address: kthonlpson(,-t)springsgov.coni
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.
F / 2.9
-�
Signa,tPA
of PermitteeJeornorate Officer,Owner,or Documented Designee Date
NI.AF-04