2017-08-02_REPORT - M1993039

• Permit No: M1993039
• IBM Index Class Name: REPORT
• Doc Date: 8/2/2017
• Doc Name: Annual Fee/Report/Map
• From: City of Cripple Creek
• 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: Steve DiCamillo
Permittee Company: City of Cripple Creek
Address: 337 E. Bennett Ave.
P.O. Box 430
Cripple Creek, CO 80813
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: Ghip
Company: City of Cripple Creek
Address: 207 C.R. 89
P.O. Box 430
Cripple Creek, CO 80813
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Can
Company: City of Cripple Creek
Address: 207 C.R. 89
P.O. Box 430
Cripple Creek, CO 80813
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 accordance with the Division approved mining and reclamation plans.
Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-A-04
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