2017-06-20_REPORT - M2006042

• Permit No: M2006042
• IBM Index Class Name: REPORT
• Doc Date: 6/20/2017
• Doc Name: Annual Fee/Report/Map
• From: MMM Partnership, LLP
• 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: Mark Kokes
Permittee Company: MMM Partnership,LLP.
Address: 15160 Hwy. 144 Lot 18
Fort Morgan,CO 80701
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Permitting Contact: Randy Schafer
Company:
Address: 40586 Conty Road 21
Haxtun,CO 80731
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Mark Kokes
Company: MMM Partnership
Address: 15160 Hwy. 144 Lot 18
Fort Morgan,CO 80701
Phone Number: [phone] q 10 _ - r h
Fax Number: ( A)6n Z` �j V
Email Address: [e-mail]
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.
Mai
Signature o P rmittee Cor orate O icer,Owner,or Documented Designee Date
M-AF-01