2017-07-28_REPORT - M2009056

• Permit No: M2009056
• IBM Index Class Name: REPORT
• Doc Date: 7/28/2017
• Doc Name: Annual Fee/Report/Map
• From: Destiny Mining, LLC
• To: DRMS
• Annual Report Year: 2016
• Email Name: MAC
• 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: Boyd Astemborski
Permittee Company: Destiny Mining, LLC
Address: 902 Collins Rd.
Colorado Springs, CO 80920
Phone Number: [phone]
Fax Number:
Email Address: 4/ /
Permitting Contact: Boyd Astemborski
Company: Destiny Mining,LLC
Address: 902 Collins Rd
Colorado Springs,CO 80920
Phone Number: [phone]
Fax Number:
1V)NC"
Email Address:
Inspection Contact: Boyd Astemborski
Company: Destiny Mining, LLC
Address: 902 Collins Rd
Colorado Springs, CO 80920
Phone Number: [phone]
Fax Number:
Email Address: ,
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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.
zold
✓/7
Signa Permittee,C raorate Officer,Owner,or Documented Designee Date
M-AF-02