2017-06-06_REPORT - M1984044

• Permit No: M1984044
• IBM Index Class Name: Report
• Doc Date: 6/6/2017
• Doc Name: Annual Fee/Report/Map
• From: Saguache County
• To: DRMS
• Annual Report Year: 2016
• Email Name: SJM
• 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: Randal H.Arredoudo
Permittee Company: Saguache County
Address: P.O. Box 476
Saguache,CO 81149
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: Ellen Cox
Company: Saguache County
Address: P.O. Box 655
Saguache, CO 81149
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: Ellen Cox
Company: Saguache County
Address: P.O. Box 655
Saguache, CO 81149
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 c ucted' cordance with the Division approved mining and reclamation plans.
Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-04