2017-09-20_REPORT - M2007034

• Permit No: M2007034
• IBM Index Class Name: REPORT
• Doc Date: 9/20/2017
• Doc Name: Annual Fee/Report/Map
• From: S & S Services
• 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: Sylvia S. Lopez
Permittee Company: S &S Services
Address: 19901 State Hwy. 12
Weston, CO 81091
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Ronald G.Thompson
Company: Peak Project Management, LLC
Address: 34115 County Road 20.8
Trinidad, CO 81082
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Richard S. Lopez
Company: S & S Services
Address: 19901 State Hwy. 12
Weston,CO 81091
Phone Number: [phone]
Fax Number: [phone]
Email Address:
1,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.
Signature of Permittee, Corporate Officer,Owner,or Documented Designee Date
M-AF-01