2017-08-07_REPORT - M1986079

• Permit No: M1986079
• IBM Index Class Name: REPORT
• Doc Date: 8/7/2017
• Doc Name: Annual Fee/Report/Map
• From: Mann Resources LLC
• To: DRMS
• Annual Report Year: 2016
• Email Name: JLE
• Media Type: D
• Archive: No

i
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: Clay Carlson
Permittee Company: Mann Resources LLC
Address: P.O. Box 247
Eastlake,CO 80614
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Permitting Contact: Clay Carlson
Company: Mann Resources LLC
Address: P.O. Box 247
Eastlake,CO 80614
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: Clay Carlson
Company: Mann Resources LLC
Address: P.O. Box 247
Eastlake,CO 80614
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
1, the undersigned, ereby tate that the information provided in this report is true and accurate,and that site operations are
being conducted ih accord4ce with the Division approved mining and reclamation plans.
lt4
Signature of Permittee Cory r to Officer, wner,or Documented Desienee Date
[ q �6
� O7