2017-05-03_REPORT - M2013006

• Permit No: M2013006
• IBM Index Class Name: REPORT
• Doc Date: 5/3/2017
• Doc Name: Annual Fee/Report/Map
• From: Huerfano County
• To: DRMS
• Annual Report Year: 2016
• 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: Melanie Bounds
Permittee Company: Huerfano County
Address: 401 Main St., Ste. 105
Walsenburg, CO 81089
Phone Number: (TI#j-13S 3053--
Fax Number: [phone]
Email Address:
Permitting Contact:
Company:
Address:
Phone Number:
Fax Number:
Email Address:
Inspection Contact: Melanie Bounds
Company: Huerfano County Government
Address: 401 Main Street, Suite 105
Walsenburg, CO 81089
Phone Number: }738 3053
CAI l Ci�
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
bei�g cond cted in accord ce with the Division approved mining and reclamation plans.
Si natu of rm' tee C� orate Officer,Owner,or Documented Designee D e
AF-04