2017-06-09_REPORT - M1982011

• Permit No: M1982011
• IBM Index Class Name: REPORT
• Doc Date: 6/9/2017
• Doc Name: Annual Fee/Report/Map
• From: Jo Ann Vota
• To: DRMS
• Annual Report Year: 2017
• Email Name: LJW
• 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: Joann Vota
Permittee Company: Jo Ann Vota
Address: 315 N. Sunburst Ln.
Durango, CO 81301
Phone Number: [phone]
Fax Number:
Email Address: Jvota&bresnan.net
Permitting Contact:
Company: Jo Ann Vota
Address: 315 N. Sunburst Ln
Durango, CO 81301
Phone Number: [phone]
Fax Number:
Email Address:
i
Inspection Contact: j
Company: Jo Ann Vota
Address: 315 N. Sunburst Ln
Durango. CO 81301
Phone Number: [phone]
Fax Number:
Email Address:
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 Permittee, Corporate Officer,Owner,or Documented Designee Date
,1-AF-01