2017-09-20_REPORT - M1978249 ‎(2)‎

• Permit No: M1978249
• IBM Index Class Name: REPORT
• Doc Date: 9/20/2017
• Doc Name: Annual Fee/Report/Map
• From: Logan County
• To: DRMS
• Annual Report Year: 2017
• 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: Rob Quint
Permittee Company: Logan County
Address: 315 Main St., Ste. 2
Sterling, CO 80751
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Rob Quint
Company: Logan County
Address: 315 Main St., Ste.2
Sterling, CO 80751
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Chad Wright
Company: Logan County
Address: 12603 CR 33
Sterling, CO 80751
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 conducte in accordance with the Division approved mining and reclamation plans.
,at. 1// "z
`7
Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-04