2017-04-12_REPORT - M2012004

• Permit No: M2012004
• IBM Index Class Name: REPORT
• Doc Date: 4/12/2017
• Doc Name: Returned Mail
• From: DRMS
• To: Superior Oilfield Svcs
• Email Name: ECS
• 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: Jack Miller
Permittee Company: Superior Oilfield Services Co.,
LTD
Address: 1011 1 lth Ave.
Greeley, CO 80631
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Michael Miller
Company: Superior Oilfield Services Co.,
LTD
Address: 14280 CR 72
P.O. Box 336356
Greeley,CO 80633
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Michael Miller
Company: Superior Oilfield Services Co.,
LTD
Address: 14280 CR 72
P.O. Box 336356
Greeley,CO 80633
Phone Number: [phone]
Fax Number: [phone]
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.
Signature of Permittee,Corporate Officer,Owner,or Documented Desiznee Date
M-AF-01