2017-08-29_REPORT - M2014028

• Permit No: M2014028
• IBM Index Class Name: REPORT
• Doc Date: 8/29/2017
• Doc Name: Annual Fee/Report/Map
• From: Huerfano County
• To: DRMS
• Annual Report Year: 2017
• 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: Melanie Bounds
Permittee Company: Huerfano County
Address: 401 Main Street, Suite 105
Walsenburg, CO 81089
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact:
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Address: 1740 Eagleri lvd. \i
P.O. Bo 20 , 1 �1 r� �� L�,S
P o,CO 81008 W C r .D L1' ` Com, X`o(, =
Phone Number:
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Fax Number: (7193 547 7071
Email Address:
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Inspection Contact: Melanie Bounds
Company: Huerfano County'
Address: 401 Main Street, Suite 105
Walsenburg, CO 81089
Phone Number: [phone]
Fax Number: [phone]
Email Address:
I,t e undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are
bein_ condtcted in accordance with the Division approved mining and reclamation plans.
Si,inatur= of Feermi> ,-Corporate Officer,Owner,or Documented Designee Date
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