2017-05-15_REPORT - M1984097

• Permit No: M1984097
• IBM Index Class Name: REPORT
• Doc Date: 5/15/2017
• Doc Name: Annual Fee/Report/Map
• From: Mineral County
• To: DRMS
• Annual Report Year: 2016
• Email Name: THM
• 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: Janelle Kukuk
Permittee Company: Mineral Bounty
Address: P.O. Box 70
Creede,CO 81130
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Mark Latour
Company: Mineral County
Address: P.O. Box 70
Creede, CO 81130 S
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Phone Number: [phone]
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Fax Number: �4 \
Email Address:
Inspection Contact: Dannie Rogers
Company: Mineral County
Address: P.O. Box 70
Creede,CO 81130
Phone Number: [phone]
Fax Number:
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.
G7
Signature of Pe i ittee Cor orate O ricer,Owner,or Documented Designee Date
M-AF-04