2017-06-27_REPORT - M1995030

• Permit No: M1995030
• IBM Index Class Name: Report
• Doc Date: 6/27/2017
• Doc Name: Annual Fee/Report/Map
• From: McAtee Construction
• To: DRMS
• Annual Report Year: 2016
• 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: Darren Gebhart
Permittee Company: McAtee Construction Company
Address: P.O. Box 1908
Sterling,CO 80751
Phone Number: [phone]
Fax Number: [phone]
Email Address: DgebhartLsimoncontractors.com
Permitting Contact: Darren Gebhart
Company: McAtee Construction Co.
Address: 220 Edwards Ave.
Sterling,CO 80751
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: Darren Gebhart
Company: McAtee Construction Co.
Address: 220 Edwards Ave.
Sterling,CO 80751
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 arc
being conducted in accordance with the Division approved mining and reclamation plans.
Construction manager —!`�'` '
Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date
\I V.n!