2017-06-27_REPORT - M2007025

• Permit No: M2007025
• IBM Index Class Name: REPORT
• Doc Date: 6/27/2017
• Doc Name: Annual Fee/Report/Map
• From: Delta County
• To: DRMS
• Annual Report Year: 2017
• Email Name: SJM
• 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: Bob Basher
Permittee Company: , Delta County
Address: 501 Palmer St Ste 227
Delta, CO 81416
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Michael Ripp
Company: MVR Resources, Inc.
Address: P.O. Box 54
Delta, CO 81416
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Larry Record
Company: Delta County
Address: 501 Palmer St Ste 227
Delta, CO 81416
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 accordance with the Division approved mining and reclamation plans.
A-0,-4,24Z 61,12c��ZV 7
Signature of Perm' ee,Corporate Officer,Owner,or Documented Desi nee Date
--------------
M-AF-04