2017-05-03_REPORT - M2014034

• Permit No: M2014034
• IBM Index Class Name: REPORT
• Doc Date: 5/3/2017
• Doc Name: Annual Fee/Report/Map
• From: Huerfano County
• To: DRMS
• Annual Report Year: 2017
• 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 Street, Suite 101
Walsenburg,CO 81089
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: Joseph V.Gagliano /
Company: Gagliano Engineering,Inc. \
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Address: P.O. Box 2520 � C
Pueblo,CO 81004 `-1 t, 0 t
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Phone Number: [phone] '
13%-3 o x 10S
Fax Number:
Email Address:
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Inspection Contact: Melanie Bounds
Company: Huerfano County
Address: 401 Main Street, Suite 105
Walsenburg,CO 81008
Phone Number: [phone]
Fax Number: [phone]
Email Address:
I,the un ersigned,hereby state that the information provided in this report is true and accurate, and that site operations are
being co ducted n accorda ce Ce Division approved mining and reclamation plans.
xi C'L 4- 21- 1'1
Signature o ermittee ate Officer,Owner,or Documented Designee Date
-AF 4