2017-07-05_REPORT - M1986074

• Permit No: M1986074
• IBM Index Class Name: REPORT
• Doc Date: 7/5/2017
• Doc Name: Annual Fee/Report/Map
• From: Kym Schure
• To: DRMS
• Annual Report Year: 2016
• Email Name: JLE
• 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: Kym A. Schure
Permittee Company: Kym A. Schure
Address: 12826 CR 37
Sterling, CO 80751
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Permitting Contact: Kym A. Schure
Company: Kym A. Schure
Address: 12826 CR 37
Sterling,CO 80751
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: Kym A. Schure
Company: Kym A. Schure
Address: 12826 CR 37
Sterling,CO 80751
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.
Signatur Permittee,Corporate Officer,Owner,or Documented DesiEnee Date
M-AF-01