2017-03-16_REPORT - M2011039

• Permit No: M2011039
• IBM Index Class Name: REPORT
• Doc Date: 3/16/2017
• Doc Name: Annual Fee/Report/Map
• From: Colorado Moss Rock, Inc.
• To: DRMS
• Annual Report Year: 2017
• Email Name: ERR
• Media Type: D
• Archive: No

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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: Kim Barickman
Permittee Company: Colorado Moss Rock, Inc.
Address: P.Q. Box 581
Rye,CO 81069
Phone Number: [phone]
Fax Number:
Email Address:
Permitting Contact: Joe P.Gagliano
Company: L J Development,Inc.
Gagliano Engineering Inc
Address: 256 N.Merrill Drive P O Box 2520
Pueblo West,CO 81007 Pueblo,CO 81004
Phone Number:
Fax Number:
Email Address:
Inspection Contact: Joe P.Gagliano
Company: L J Development,Inc.
Gagliano Engineering Inc
Address: 256 N.Merrill Drive P Box zszo
Pueblo West,CO 81007 Puee blo,co 81004
Phone Number:
Fax Number:
Email Address:
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.
Signature of Permittee,Corporate Officer,Owner,or Documented Desienee Date
M AFAI