2017-09-18_REPORT - M1991104 ‎(2)‎

• Permit No: M1991104
• IBM Index Class Name: REPORT
• Doc Date: 9/18/2017
• Doc Name: Annual Fee/Report/Map
• From: Gunnison County
• 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: Marlene Crosby
Permittee Company: Gunnison County
Address: 195 Basin Park Dr.
Gunnison, CO 81230
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Marlene Crosby
Company: Gunnison County Public Works
Address: 195 Basin Park Dr.
Gunnison, CO 81230
Phone Number: [phone]
Fax Number: 970-641 -81 20
Email Address:
[e-mail]
Inspection Contact: Allen Moores
Marlene Crosby
Company: Gunnison County Public Works
Dept.
Address: 195 Basin Park Dr.
Gunnison, CO 81230
Phone Number: [phone]
Fax Number: [phone]
Email Address:
[e-mail] !/
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.
` cL�-L- ^A 9/14/17
Si ture of Permittee Cor ,orat fficer,Owner,or Documented Designee Date
M-AF-04