2017-09-07_REPORT - M2014038

• Permit No: M2014038
• IBM Index Class Name: REPORT
• Doc Date: 9/7/2017
• Doc Name: Annual Fee/Report/Map
• From: Routt County
• To: DRMS
• Annual Report Year: 2016
• Email Name: GRM
• 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: Mike Mordi
Permittee Company: Routt County
Address: 136 6th Street
P.O. Box 773598
Steamboat Springs, CO 80477
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Mike Mordi
Company: Routt County Road and Bridge
Address: 136 6th Street
P.O. Box 773598
Steamboat Springs, CO 80477
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Mike Mordi
Company: Routt County Road and Bridge
Address: 136 6th Street
P.O. Box 773598
Steamboat Springs, CO 80477
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 condu ted in accordance with the Division ap oved mining and reclamation plans.
k1l IR
Signditure of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-04