2017-06-20_REPORT - M1982075

• Permit No: M1982075
• IBM Index Class Name: REPORT
• Doc Date: 6/20/2017
• Doc Name: Annual Fee/Report/Map
• From: Alvin Mosch - Patricia Mosch
• To: DRMS
• Annual Report Year: 2017
• Email Name: MAC
• 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: Alvin Mosch
Permittee Company: Alvin Mosch-Patricia Mosch V
Address: Phoenix Gold Mine
P.O. Box 3236
Idaho Springs,CO 80452
Phone Number: [phone]
Fax Number:
Email Address:
Permitting Contact: David Mosch V
Company: Alvin MoscH-Patricia Mosch U
Address: P.O. Box 1484
Idaho Springs, CO 80452 V
Phone Number: [phone]
v
Fax Number:
Email Address: [e-mail] V
Inspection Contact: Alvin Mosch
Y
Company: Alvin Mosch-Patricia Mosch
Address: Phoenix Gold Mine
P.O. Box 3236
Idaho Springs, CO 80452 �j��l� 5)7R Vv6
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 conducted in accordance with the Division approved mining and reclamation plans.
G-1Z-i- �o i
Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-02