2017-04-17_REPORT - M1982147

• Permit No: M1982147
• IBM Index Class Name: REPORT
• Doc Date: 4/17/2017
• Doc Name: Annual Fee/Report/Map
• From: Adams County
• To: DRMS
• Annual Report Year: 2017
• Email Name: JLE
• 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: Nathan Mosely
Permittee Company: Adams County
Address: 9755 Henderson Rd
Brighton, CO 80601
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: R i c1c.Aptdersea. �� ^ Ctih
Company: Adams County
Address: 9755 Henderson Rd
Brighton, CO 80601
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: -R ick--A&;4L—,w; 4c4.4^
Company: Adams County
Address: 9755 Henderson Rd
Brighton, CO 80601
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
being conducted in accordance with the Division approved mining and reclamation plans.
Sig ature of Permitte orate Officer,Owner,or Documented Desienee D to
M-AF-04