2017-05-10_REPORT - M2006034

• Permit No: M2006034
• IBM Index Class Name: REPORT
• Doc Date: 5/10/2017
• Doc Name: Annual Fee/Report/Map
• From: Glacier Peak Mining
• To: DRMS
• Annual Report Year: 2016
• Email Name: ERR
• 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: Joseph Dorris
Permitt e Company: Glacier Peak Mining, LLC
Address: 2920 Cedar Hts Dr.
Colorado Springs,CO 80904
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Permitting Contact: Joseph Dorris
Company: Glacier Peak Mining,LLC
Address: 2920 Cedar Hts Dr.
Colorado Springs,CO 80904
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: Joseph Dorris
Company: Glacier Peak Mining,LLC
Address: 2920 Cedar Hts Dr.
Colorado Springs, CO 80904
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
I,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.
Signature of Perm' ee C6riporate Officer,Owner,or Documented Designee Date
M-AF-02