2017-05-03_REPORT - M1979210

• Permit No: M1979210
• IBM Index Class Name: REPORT
• Doc Date: 5/3/2017
• Doc Name: Annual Fee/Report/Map
• From: Morgan 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: John Goodman
Permittee Company: Morgan County
Address: 17303 CR S
Fort Morgan, CO 80701
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: Joe Intermill
Company:
Address: 43379 RD 51
Ault,CO 80610
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: John Goodman
Company: Morgan County
Address: 17303 CR S
Fort Morgan,CO 80701
Phone Number: [phone]
Fax Number: [phone]
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' acc dance with the Division approved mining and reclamation plans.
Vx
Z11of Permittee, orporate Officer,Owner,or Documented Desiunee Date
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