2017-06-29_REPORT - M1988081

• Permit No: M1988081
• IBM Index Class Name: Report
• Doc Date: 6/29/2017
• From: DRMS
• To: Harry Covey
• Annual Report Year: 2017
• 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:

Harry Covey
Permittee Company:

Harry Covey
Address:

1600 Bain Dr.
Erie, CO 80516

Phone Number:

[phone]
Fax Number:
Email Address: [e-mail]
Permitting Contact:

Harry Covey
Company:

Harry Covey
Address:

479 County Raod 83
Boulder, CO 80302

Phone Number:

[phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact:

Harry Covey
Company:

Harry Covey
Address:

479 County Road 83
Boulder, CO 80302

Phone Number:

[phone]
Fax Number:
Email Address: [e-mail]

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.

Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date
M-AF-02