2017-08-02_REPORT - M2006029

• Permit No: M2006029
• IBM Index Class Name: REPORT
• Doc Date: 8/2/2017
• Doc Name: Annual Fee/Report/Map
• From: Grand County
• To: DRMS
• Annual Report Year: 2016
• Email Name: PSH
• 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: Bill Clark
Permittee Company: Grand County
Address: P.O. Box 9
Granby, CO 80446
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Bill Clark
Company: Grand County
Address: P.O. Box 9
Granby, CO 80446
Phone Number: (970)887-242P
Fax Number: [phone]
Email Address:
Inspection Contact: lnderbr-in C
Company: Grand County
Address: P.O. Box 9
Granby, CO 00" (J 6L,x" y
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Phone Number: [phone]
Fax Number: [phone]
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 a r n with the Division approved mining and reclamation plans.
Signature of Permittedy Corporate Officer,Owner,or Documented Desiznee Date
M-AF-04
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