2017-09-20_REPORT - M2004028

• Permit No: M2004028
• IBM Index Class Name: REPORT
• Doc Date: 9/20/2017
• Doc Name: Annual Fee/Report/Map
• From: Michele and Frederick Eicher
• To: DRMS
• Annual Report Year: 2016
• Email Name: MAC
• 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: Michele M. Eichler
Permittee Company: Michele M and Frederick V
Eichler IV
Address: 22250 CR 44
Aguilar, CO 81020
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Permitting Contact: Michele M.Eichler
Company: Michele M and Frederick V
Eichler IV
Address: 22250 CR 44
Aguilar, CO 81020
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: Michele M.Eichler
Company: Michele M and Frederick V
Eichler IV
Address: 22250 CR 44
Aguilar, CO 81020
Phone Number: [phone]
Fax Number:
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.
7/0
Signati Permittee, Corp rate Officer,Owner,or Documented Desienee Date
M-AF-01