2017-04-12_REPORT - M1980041 ‎(3)‎

• Permit No: M1980041
• IBM Index Class Name: REPORT
• Doc Date: 4/12/2017
• Doc Name: Annual Fee/Report/Map
• From: James L. Treat
• To: DRMS
• Annual Report Year: 2017
• Email Name: DMC
• 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: James L.Treat
Permittee Company: James L Treat
Address: 225 G St
Salida,CO 81201
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact:
Company: James L Treat
Address: 225 G St
Salida,CO 81201
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact:
Company: James L Treat
Address: 225 G St
Salida,CO 81201
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.
t�-tom
Signature of mittee Corpora, Officer.Owner,or Documented Designee Date
M-AF-0I