2017-05-30_M1997089_Annual Fee Notice ARCHIVE

• Permit No: M1997089A
• IBM Index Class Name: Report
• Doc Date: 5/30/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Daren Stone
• Annual Report Year: 2017
• Media Type: D
• Archive: Yes

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:

Daren R. Stone
Permittee Company:

Daren Stone
Address:

P.O. Box 1568
Cortez, CO 81321

Phone Number:

[phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact:

Company:

Address:

Phone Number:

Fax Number:
Email Address:
Inspection Contact:

Company:

Daren Stone
Address:

24600 County Road “P”
Dolores, CO 81323

Phone Number:

[phone]
Fax Number:
Email Address:

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 Permittee, Corporate Officer, Owner, or Documented Designee Date
M-AF-01