2017-09-20_REPORT - M1981058 ‎(2)‎

• Permit No: M1981058
• IBM Index Class Name: REPORT
• Doc Date: 9/20/2017
• Doc Name: Annual Fee/Report/Map
• From: Thomas & Ginger Latham
• To: DRMS
• Annual Report Year: 2017
• 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: Thomas F.Latham
Permittee Company: Thomas F&Ginger L Latham
Address: P.O. Box 66
DeBeque,CO 81630
Phone Number: [phone]
Fax Number:
Email Address:
Permitting Contact:
Company: Thomas F&Ginger L Latham
Address: P.O. Box 66
DeBeque, CO 81630
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact:
Company: Thomas F&Ginger L Latham
Address: P.O. Box 66
DeBeque, CO 81630
Phone Number: [phone]
Fax Number:
Email Address:
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.
�a A '?6( jam
Signature of Permittee or orate Officer,Owner,or Documented Desiznee Date
M-AF-01