2017-09-08_REPORT - M2000072

• Permit No: M2000072
• IBM Index Class Name: REPORT
• Doc Date: 9/8/2017
• Doc Name: Annual Fee/Report/Map
• From: Lindsey Canyon, LLC
• To: DRMS
• Annual Report Year: 2016
• Email Name: DMC
• 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: Gary W. Cooper
Permittee Company: Lindsey Canyon,LLC
Address: 11554 64.50 Road
Montrose, CO 81401
Phone Number: [phone]
Fax Number: [phone]
Email Address: Gjlcooper'u hotmail.com
Permitting Contact: Gary W. Cooper
Company: Lindsey Canyon,LLC
Address: 11554 64.50 Road
Montrose,CO 81401
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: Gary W. Cooper
Company: Lindsey Canyon,LLC
Address: 11554 64.50 Road
Montrose,CO 81401
Phone Number: [phone]
Fax Number:
Email Address:
1,the undersigned.hereby state that the information provided in this report is true and accurate, and that site operations are
being cond d in accordance with the Division approved mining and reclamation plans.
Signature f ermittee Coro to Officer,Owner,or Documented Designee Date
NI-AF-01