2017-06-29_REPORT - M1981121

• Permit No: M1981121
• IBM Index Class Name: REPORT
• Doc Date: 6/29/2017
• Doc Name: Annual Fee/Report/Map
• From: S & K No. 1, LLC
• To: DRMS
• Annual Report Year: 2016
• Email Name: TC1
• 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: Joe Kraig
Permittee Company: S &K No. 1, LLC
Address: P.O. Box 49681
Colorado Springs, CO 80949
Phone Number: [phone]
Fax Number:
Email Address:
Permitting Contact: Joe Kraig
Company: S &K No. 1, LLC
Address: P.O. Box 49681
Colorado Springs, CO 80949
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: Joe Kraig
Company: S &K No. 1, LLC
Address: P.O. Box 49681
Colorado Springs, CO 80949
Phone Number: [phone]
Fax Number:
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.
Signature of Permitte or o e Officer,Ow r,or Documented Designee Date
M-AF-01