2017-10-03_REPORT - M2010037

• Permit No: M2010037
• IBM Index Class Name: REPORT
• Doc Date: 10/3/2017
• Doc Name: Annual Fee/Report/Map
• From: Elva Masters
• To: DRMS
• Annual Report Year: 2017
• Email Name: ECS
• 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: Elva Masters
Permittee Company: Elva Masters
Address: 25901 US Highway 36
P.O. Box 47
Anton, CO 80801
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact:
Company:
Address:
Phone Number:
Fax Number:
Email Address:
Inspection Contact: Elva Masters
Company: Elva Masters
Address: 25901 US Highway 36
P.O. Box 47
Anton,CO 80801
Phone Number: [phone]
Fax Number: [phone]
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.
"71(i4 - ��
9
Signature of Permittee or ora a Officer,Owner,or Documented Designee Date
M-AF-01