2017-06-27_REPORT - M1990070

• Permit No: M1990070
• IBM Index Class Name: Report
• Doc Date: 6/27/2017
• Doc Name: Annual Fee/Report/Map
• From: San Juan County
• To: DRMS
• Annual Report Year: 2016
• 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:
Perinittee Contact:
Louis K. Girodo
Permittee Company:
San Juan County
Address:
1512 Greene St
P.O. Box 466
Silverton, CO 81433
Phone Number:
[phone]
Fax Number:
[phone]
Email Address:
SjroadsCaoutlook.com
Permitting Contact:
Louis K. Girodo
Company:
San Juan County
Address:
1512 Greene St
P.O. Box 466
Silverton, CO 81433
Phone Number:
[phone]
Fax Number:
Email Address:
[e-mail]
siroltS 1V O-J4IWK. Co rn
Inspection Contact:
Louis K. Girodo
Company:
San Juan County
Address:
1512 Greene St
P.O. Box 466
Silverton, CO 81433
Phone Number:
[phone]
�7a- iB-7- gg32
Fax Number:
Email Address:
[e-mail]
OM S0Of-4169k.Ca.y+
1, 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
re of Permittee. Corporate Officer, Owner, or Documented Designee Date
'1 5F .;