2017-04-04_REPORT - M1980246

• Permit No: M1980246
• IBM Index Class Name: REPORT
• Doc Date: 4/4/2017
• Doc Name: Annual Fee/Report/Map
• From: Anthony Zellitti
• To: DRMS
• Annual Report Year: 2017
• Email Name: LJW
• Media Type: D
• Archive: No

Page 5 of 5
Division records indicate the following permitteellandowner 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: Anthony Zellitti
Permittee Company: Anthony Zellitti
Address: 2001 CR 300
Durango,CO 81301
Phone Number: [phone]
Fax Number: (970)5634238
Email Address:
Permitting Contact:
Company: Anthony Zellitti
Address: 2001 CR 300
Durango,CO 81301
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact:
Company: Anthony Zellitti
Address: 2001 CR 300
Durango,CO 81301
Phone Number: [phone]
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
bein cted in accordance with the Division approved mining and reclamation plans.
Sign ture of Permittee,Corporate Officer,Owner,or Documented Designee date
M-AF-01