2017-03-17_REPORT - M1998103

• Permit No: M1998103
• IBM Index Class Name: REPORT
• Doc Date: 3/17/2017
• Doc Name: Annual Fee/Report/Map
• From: Town of Limon
• To: DRMS
• Annual Report Year: 2017
• Email Name: PSH
• 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: Dave Stone
Permittee Company: Town of Limon
Address: P.O.Box 9
Limon,CO 80828
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Dave Stone
Company: Town of Limon
Address: P.O. Box 9
Limon, CO 80828
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: Dave Stone
Company: Town of Limon
Address: P.O. Box 9
Limon, CO 80828
Phone Number: [phone]
Fax Number:
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.
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Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-04