2017-07-28_REPORT - M2010036

• Permit No: M2010036
• IBM Index Class Name: REPORT
• Doc Date: 7/28/2017
• Doc Name: Annual Fee/Report/Map
• From: Rick Ensminger
• To: DRMS
• Annual Report Year: 2016
• Email Name: ERR
• 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: Rick Ensminger
Permittee Company: Rick Ensminger
Address: P.O. Box 276
Haxtun,CO 80731
Phone Number: [phone]
Fax Number:
Email Address:
Permitting Contact: Rick Ensminger
Company: Rick Ensminger
Address: 3500 Highway 6
Haxtun,CO 80731
Phone Number: [phone]Fax Number:
Email Address:
Inspection Contact: Rick Ensminger
Company: Rick Ensminger
Address: P.O.Box 276
Haxtun,CO 80731
Phone Number: [phone]
SZO f o'1 O� (/
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.
E - Sh
Signature of Permittee,Corporate Officer, ner or Documented Designee Date
M-AF-01