2017-07-26_M1986102_Annual Fee Notice ARCHIVE

• Permit No: M1986102A
• IBM Index Class Name: Report
• Doc Date: 7/26/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Collins Morehead, LLC
• Annual Report Year: 2017
• Media Type: D
• Archive: Yes

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:

Dan Collins
Permittee Company:

Collins Morehead, LLC
Address:

1417 South Grandview Drive
Tempe, AZ 85281

Phone Number:

[phone]
Fax Number:
Email Address: [e-mail]
Permitting Contact:

Dan Collins
Company:

Collins Morehead, LLC
Address:

1417 South Grandview Drive
Tempe, AZ 85281

Phone Number:

[phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact:

Dan Collins
Company:

Collins Morehead, LLC
Address:

1417 South Grandview Drive
Tempe, AZ 85281

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.

Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date
M-AF-01