2017-06-20_REPORT - M1985115

• Permit No: M1985115
• IBM Index Class Name: REPORT
• Doc Date: 6/20/2017
• Doc Name: Annual Fee/Report/Map
• From: J Pat and Lila N Greer
• 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: J.Pat Greer
Permittee Company: J Pat a d Lila N Greer
Address: 8097 CR 100
Hesperous,CO 81326
Phone Number: [phone]
Fax Number:
Email Address:
Permitting Contact:
Company: J Pat and Lila N Greer
Address: 8097 CR 100
Hesperous,CO 81326
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact:
Company: J Pat and Lila N Greer
Address: 8097 CR 100
Hesperous,CO 81326
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.
'�e/ - /&/,- -•/ rz
Sigq6tuireof Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-01