2017-03-08_REPORT - M1992074

• Permit No: M1992074
• IBM Index Class Name: REPORT
• Doc Date: 3/8/2017
• Doc Name: Annual Fee/Report/Map
• From: City of Colorado Springs
• To: DRMS
• Annual Report Year: 2017
• 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: -Patti;Zietlovw- Zack Temple
Permittee Company: City of Colorado Springs
Address: P.O.Box 1103
Mail Code 940
Colorado Springs,CO 80947
Phone Number: {7-14}{68-4!71— [phone]
Fax Number: [phone]
Email Address: -Pziet}mv@e9marg—
[e-mail]
Permitting Contact: Philip C.Saletta
Company: City of Colorado Springs Water
Dept.
Address: 30 S.Nevada Suite 603
Colorado Springs,CO 80903
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: `ter
Sean Evans
Company: City of Colorado Springs Water
Dept.
Address: 404 W.Fentanere 703 East Las Vegas Street
Colorado Springs, CO 80903
Phone Number: [phone] [phone]
Fax Number:
Email Address: [e-mail]
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.
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Signature of a ttee or orate Officer,Owner,or Documented Designee Date
M-AF44