2017-04-14_REPORT - M1996076

• Permit No: M1996076
• IBM Index Class Name: REPORT
• Doc Date: 4/14/2017
• Doc Name: Annual Fee/Report/Map
• From: Rudolph Fontanari
• To: DRMS
• Annual Report Year: 2017
• Email Name: SJM
• 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: Rudolph Fontanari
Permittee Company: Rudolph Fontanari
Address: 3316 E 3/4 Rd Rt 1
Clifton, CO 81520
Phone Number: [phone]
Fax Number:
Email Address:
Permitting Contact: Rudolph Fontanari
Company: Rudolph Fontanari
Address: 3316 E 3/4 Road
Clifton, CO 81520
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: Rudolph Fontanari
Company: Rudolph Fontanari
Address: 3316 E 3/4 Road
Clifton,CO 81520
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.
-I
Signature of Kermittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-01