2017-09-05_REPORT - M1989024

• Permit No: M1989024
• IBM Index Class Name: Report
• Doc Date: 9/5/2017
• Doc Name: Annual Fee/Report/Map
• From: Edward M. Yaklich
• To: DRMS
• Annual Report Year: 2017
• Email Name: TC1
• Media Type: D
• Archive: No

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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: f13
Jeannette J. Yaklich-Houston
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Permittee Company:
Edward M. Yaklich
Address:
1180 County Road 129
Westcliffe, CO 81252
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5
Phone Number:
[phone]
Fax Number:
Email Address:
Permitting Contact:
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Company:
Address:
Phone Number:
Fax Number:
Email Address:
Inspection Contact:
Company:
Edward M. Yaklich
Address:
112 Cottage Ln
Canon City, CO 8I212
Phone Number:
Fax Number:
Email Address:
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1, 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.
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of Permittifi. C norate Oftice . Owner. 6r Documented Designee Date