2017-09-11_REPORT - M1983158

• Permit No: M1983158
• IBM Index Class Name: REPORT
• Doc Date: 9/11/2017
• Doc Name: Annual Fee/Report/Map
• From: MJ Cadgene
• 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: M.J.Cadgene �—
Permittee Company: M J Cadgene
Address: P.O. Box 10
Redvale, CO 81431
Phone Number: [phone]
Fax Number: [phone]
Email Address: Mjctelluride a')hughes.net
Permitting Contact:
Company: M J Cadgene
Address: P.O. Box 10
Redvale,CO 81431
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact:
Company: M J Cadgene
Address: P.O. Box 10
Redvale,CO 81431
Phone Number: [phone]
Fax Number:
Email Address:
I,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.
(� LV4'k � q 6 Zvi 7
Signature ermitte or orate Officer,Owner,or Documented Designee ate
M-AF-U 1