2017-06-29_REPORT - M2004042

• Permit No: M2004042
• IBM Index Class Name: Report
• Doc Date: 6/29/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Ralph Porco, Randy Porco
• 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:

Ralph Porco
Permittee Company:

Ralph Porco, Randy Porco
Address:

111 50 FDR 255
La Jara, CO 81140

Phone Number:

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

Ralph Porco
Company:

Ralph Porco, Randy Porco
Address:

111 50 FDR 255
La Jara, CO 81140

Phone Number:

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

Ralph Porco
Company:

Ralph Porco, Randy Porco
Address:

111 50 FDR 255
La Jara, CO 81140

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-01