2017-06-19_REPORT - M1978162

• Permit No: M1978162
• IBM Index Class Name: REPORT
• Doc Date: 6/19/2017
• Doc Name: Annual Fee/Report/Map
• From: Morgan County
• To: DRMS
• Annual Report Year: 2017
• Email Name: JLE
• 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: John Goodman
Permittee Company: Morgan County
Address: 17303 CR S
Fort Morgan,CO 80701
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: John Goodman
Company: Morgan County
Address: 17303 CR S
Fort Morgan, CO 80701
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: John Goodman
Company: Morgan County
Address: 17303 CR S
Fort Morgan, CO 80701
Phone Number: [phone]
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 ccor nce with t ivision approved mining and reclamation plans.
Signatu e o ermittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-u4