2017-07-06_REPORT - M1995023

• Permit No: M1995023
• IBM Index Class Name: Report
• Doc Date: 7/6/2017
• Doc Name: Annual Fee/Report/Map
• From: Corkle Construction
• To: DRMS
• Annual Report Year: 2016
• Email Name: PSH
• Media Type: D
• Archive: No

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 E.Corkle
Permitt6e Company: Corkle Construction I
Address: 34612 Hwy. 14
P.O.Box 306
Walden,CO 80480
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: Hughie E.Corkle
Company: Corkle Construction
Address: 34612 Hwy. 14
P.O. Box 306
Walden,CO 80480
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: Hughie E.Corkle
Company: Corkle Construction
Address: 34612 Hwy. 14
P.O.Box 306
Walden,CO 80480
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.
-AF-01 ur of Permittee,Corporate Officer Owner,or Documented Designee
N-Af-0i Date