2017-04-25_REPORT - M1980013

• Permit No: M1980013
• IBM Index Class Name: REPORT
• Doc Date: 4/25/2017
• Doc Name: Annual Fee/Report/Map
• From: Park County
• To: DRMS
• Annual Report Year: 2017
• Email Name: MAC
• 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: Tammie Crawford
Permittee Company: Park County
Address: P.O. Box 147
Fairplay, CO 80440
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: Konrad Oker
Company: Park County
Address: P.O. Box 147
Fairplay,CO 80440
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: Konrad Oker
Company: Park County
Address: P.O. Box 147
Fairplay,CO 80440
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.
n
Signature of Permitte Co o ate Officer,Owner,or Documented Designee 6ate
M-AF-04