2017-05-31_REPORT - M2007030

• Permit No: M2007030
• IBM Index Class Name: Report
• Doc Date: 5/31/2017
• Doc Name: Annual Fee/Report/Map
• From: City of Rifle
• To: DRMS
• Annual Report Year: 2017
• Email Name: ACY
• 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: Rick Barth
Permittee Company: I City of Rifle
Address: 202 Railroad Avenue
Rifle,CO 81650
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Rod!6MilrM*R«„- ow
Company: City of Rifle
Address: Public Works Director
202 Railroad Avenue
Rifle,CO 81650
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: R"""440ft At/,kE;Aca aaAv
Company: City of Rifle
Address: Public Workrbireetun ,/Ik-,qtt",'CA/49479"1
202 Railroad Avenue
Rifle,CO 81650
Phone Number: (970) 45 tFI
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 conducted in accordance with the Division approved mining and reclamation plans.
Signature of Permitt ,Coryorate Officer,Owner,or Documented Designee Date
M-AF-04