2017-05-05_REPORT - M1984156

• Permit No: M1984156
• IBM Index Class Name: REPORT
• Doc Date: 5/5/2017
• Doc Name: Annual Fee/Report/Map
• From: Grand County
• To: DRMS
• Annual Report Year: 2017
• Email Name: PSH
• 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: Ken Haynes
Permittee Company: Grand County
Address: P.O. Box 9
Granby, CO 80446
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: des
Silt e r
Company: Grand County
Address: P.O. Box 9
Granby, CO 80446
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Ken C.Haynes
Company: Grand County
Address: P.O. Box 9
Granby, CO 80446
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 in accordance with the Division approved mining and reclamation plans.
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Signature of P mittee Cor orate Officer,Owner,or Documented Designee Date
M-AF-04