2017-07-20_REPORT - M1983112

• Permit No: M1983112
• IBM Index Class Name: Report
• Doc Date: 7/20/2017
• Doc Name: Annual Fee/Report/Map
• From: Kiowa County
• To: DRMS
• Annual Report Year: 2017
• Email Name: AME
• Media Type: D
• Archive: No

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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:
Allen W. Watts
Permittee Company:
Kiowa County
Address:
P.O. Box 100
Eads, CO 81036
Phone Number:
[phone]
Fax Number:
[phone]
Email Address:
Permitting Contact:
Allen Watts
Company:
Kiowa County
Address:
P.O. Box 100
Eads, CO 81036
Phone Number:
[phone]
Fax Number:
Email Address:
Inspection Contact:
Allen Watts
Company:
Kiowa County
Address:
P.O. Box 591
Eads, CO 81036
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.
L � 2 -1? --0
of Permittee. Corporate Officer, Owner, or Documented Designee Date
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