2017-09-28_REPORT - M2013070

• Permit No: M2013070
• IBM Index Class Name: REPORT
• Doc Date: 9/28/2017
• Doc Name: Annual Fee/Report/Map
• From: Liberty Mining, LLC
• 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: Michael D. Shumway
`
Permittee Company: Liberty Mining, LLC
Address: 1300 South Highway 191
P.O. Box 1032
Moab, UT 84532
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Cynthia A.Gray
Company: Soulder, Miller and Associates
L&x. er)
Address: 121 San Juan Blvd.
Farmington,NM 87401
Phone Number: [phone]
Fax Number: [phone]
Email Address: C` .3 C Sck►c.rnw-11 er_ctxn
Inspection Contact: Michael D. Shumway
Company: Liberty Mining,LLC
Address: 1300 South Highway 191
P.O. Box 1032
Moab, UT 84532
Phone Number: [phone]
Fax Number: [phone]
Email Address: cr.U?C-NbC .fie , t.brel
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.
1(.11-4- -----r f
SignaturPermittee orate Officer,Owner, Documented Designee Date
11.
M-AF-02