2017-09-12_REPORT - M1995034

• Permit No: M1995034
• IBM Index Class Name: REPORT
• Doc Date: 9/12/2017
• Doc Name: Annual Fee/Report/Map
• From: Bachus Pit
• To: DRMS
• Annual Report Year: 2016
• Email Name: SJM
• 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:
Alta^
P ittee Company:
mx0i'mi 14- LQ 14
A dress: `P x 1 13
Phone Number:
Fax Number: /
Email Address: hm
r/
Permitting Contact:
AAn"m Akm�'A-V-
Company:
1
Address:
Co'sI
Phone Number:
—lbn q-
Fax Number: y
Email Address: 7
Inspection Contact: ,
Company:
Address: p� x 1 31
Phone Number:
Fax Number.
Email Address:
I,the undersigned, hereby state that the information provided*inthis report is true and accurate, and that site operations are
being conducted in accordance with the Division approved mining and reclamation plans.
694-0"aLe=,O�-
9__.
Signature of Feimiftee,Corporate Officer,Owner,or Documented Designee Date
M•AF-01