2016-07-08_REPORT - M2011049

• Permit No: M2011049
• IBM Index Class Name: REPORT
• Doc Date: 7/8/2016
• Doc Name: Annual Fee/Report/Map
• From: City of Greeley
• To: DRMS
• Annual Report Year: 2015
• Email Name: ECS
• Media Type: D
• Archive: No

Pace 5 of-5
Division records indicate the follo"ing permittee contact information. If this information is not current.please type or print
current contact information:
permittee Contact: Eric Reckentine
Anastasia Frantsova
Pennittee Company: City of Greeley
Address: 1 100 10th Street. Suite 300
Greeleti. CO 80631
Phone Number:
[phone]
Fax Number: [phone]
Email Address:
1. the undersiLned. hereby state that the information provided in this report is true and accurate.and that site operations are
bein-, conducted in accordance \Kith the Divi,ion approved mining and reclamation plans.
A'a 5 k 1 4, �rmk��CYQ- 71111-016
Signature of Permittee.Corporate Officer,Owner,or Documented Designee Date