2017-05-15_REPORT - M2001012

• Permit No: M2001012
• IBM Index Class Name: REPORT
• Doc Date: 5/15/2017
• Doc Name: Annual Fee/Report/Map
• From: Washington 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: Jason Lockard
Permittee Company: Washington County
Address: 150 Ash Avenue
Akron, CO 80720
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: Jason Lockard
Company: Washington County
Address: 150 Ash Avenue
Akron,CO 80720
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Jason Lockard
Company: Washington County
Address: 150 Ash Avenue
Akron,CO 80720
Phone Number: [phone]
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
being,caiiducted in a rdance with the Division approved mining and reclamation plans.
ature of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-04