2017-05-30_REPORT - M1981250

• Permit No: M1981250
• IBM Index Class Name: REPORT
• Doc Date: 5/30/2017
• Doc Name: Annual Fee/Report/Map
• From: Yuma 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:
PermitteeContact: Don Marr DECEIVED
Permittee Company: Yuma County
MAY 3 0 2017
Address: 1310 S. Blake St.
Wray, CO 80758 DIVISION C" ;RECLAMATION,
MIN & INERALS
4mv. 7PnQRT M
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Don Marr
Company: Yuma County
Address: 1310 S. Blake St.
Wray, CO 80758
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Inspection Contact: Don Marr
Company: Yuma County
Address: 1310 S. Blake St.
Wray, CO 80758
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
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.
Signature of P mitt`ee,Corporate Officer,Owner,or Documented Designee Date
M-1F-04 `` �� -0