2017-06-29_REPORT - M1978102

• Permit No: M1978102
• IBM Index Class Name: REPORT
• Doc Date: 6/29/2017
• Doc Name: Annual Fee/Report/Map
• From: Shipps Farms LP
• To: DRMS
• Annual Report Year: 2016
• Email Name: ECS
• 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: Debbie Shipps
PI ermittee Company: Shipps Farms L.P.
Address: 17164 WCR 100
Nunn,CO 80648
Phone Number: [phone]
Fax Number:
Email Address:
Permitting Contact: Debbie Shipps
Company: Shipps Farms L.P.
Address: 17164 WCR 100
Nunn,CO 80648
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: Debbie Shipps
Company: Shipps Farms L.P.
Address: 17164 WCR 100
Nunn,CO 80648
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.
Signatyle of Permi Coro fficer,Owner,or Documented Desisnee Date
M-AF-04