2017-07-28_REPORT - M1977546

• Permit No: M1977546
• IBM Index Class Name: REPORT
• Doc Date: 7/28/2017
• Doc Name: Annual Fee/Report/Map
• From: Brice F Lee & Phyllis J Lee
• To: DRMS
• Annual Report Year: 2016
• Email Name: LJW
• 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: Brice F.Lee
Permittee Company: Brice F Lee&Phyllis J Lee
Address: 940 CR 119
Hesperus, CO 81326
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact:
Company: Brice F Lee&Phyllis J Lee
Address: 940 CR 119
Hesperus, CO 81326
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact:
Company: Brice F Lee&Phyllis J Lee
Address: 940 CR 119
Hesperus,CO 81326
Phone Number: [phone]
Fax Number: 5Ty, v
Email Address:
1,the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are
being conducte accor e with the Division approved mining and reclamation plans. Z z
Signa a of Permittee Corporate Office , caner o Documented Designe bate
M-AF-01