2017-07-21_REPORT - M1977081

• Permit No: M1977081
• IBM Index Class Name: REPORT
• Doc Date: 7/21/2017
• Doc Name: Annual Fee/Report/Map
• From: Cottonwood Land and Farms, LLC
• To: DRMS
• Annual Report Year: 2016
• Email Name: PSH
• Media Type: D
• Archive: No

Pagc 5 of 5
Division records indicate the following permittee/landowner contact infonnation(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: Bill McDowell
Permittee Company: Cottonwood Land and Farms,
LLC
Address: P.O. Box 229
Boulder,CO 80306
Phone Number: [phone]
Fax Number:
Email Address: _ [e-mail]
Permitting Contact: Bill McDowell
Company: Cottonwood LAnd and Farms,
LLC
Address: P.O. Box 229
Boulder,CO 80306
Phone Number: [phone]
Fax Number:
Email Address: Din_ Same as Above
Inspection Contact: Bill McDowell
Company: Cottonwood LAnd and Farms,
LLC
Address: P.O. Box 229
Boulder,CO 80306
Phone Number: [phone]
Fax Number:
Email Address: Dnr -__ -� -
- Same as Above
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.
July 21, 2017
Signature of Permittee,Corporate Officer,Owner,or Documented DesiZnee Date
%4-AF-Ua