2017-08-04_REPORT - M2005032

• Permit No: M2005032
• IBM Index Class Name: REPORT
• Doc Date: 8/4/2017
• Doc Name: Annual Fee/Report/Map
• From: JC Farms Inc
• To: DRMS
• Annual Report Year: 2016
• Email Name: ECS
• 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: Jeff Sprague
Permittee Company: JC Farms Inc
Address: 55184 Co Rd ZZ
Yuma, CO 80759
Phone Number: [phone]
Fax Number:
Email Address: Jcfarms [e-mail]
Permitting Contact: Jeff Sprague
Company: JC Farms Inc
Address: 55184 Co Rd 22
Yuma, CO 80759
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: Jeff Sprague
Company: JC Farms Inc
Address: 55184 Co Rd 22
Yuma, CO 80759
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
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.
/U - 30 -0
SignaturC df0er!Mtte4,Corporate Officer,Owner,or Documented Desienee Date
M-AF-01