2017-10-03_REPORT - M2012052

• Permit No: M2012052
• IBM Index Class Name: REPORT
• Doc Date: 10/3/2017
• Doc Name: Annual Fee/Report/Map
• From: Cripple Creek & Victor Gold Mining Company
• To: DRMS
• Annual Report Year: 2017
• Email Name: ERR
• 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: Meg Burt
Permittee Company: Cripple Creek&Victor Gold
MiningCom an
Address: 100 N 3rd Street
P O Box 191
Victor, CO 80860
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Chris Hanks JUS�-1
Company: Cripple Creek&Victor Gold
MiningCom an
Address: 100 N 3rd Street
P O Box 191
Victor, CO 80860
Phone Number: [phone] / �8q w ga14 (.O
Fax Number: [phone] l
Email Address: J�,t6'�1V►,1.i1��
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Inspection Contact: Cheyne Mann
1.1, '►V1 �l S
Company: Cripple Creek&Victor Gold
MiningCom an
Address: 100 N 3rd Street
P O Box 191
Victor, CO 80860
Phone Number: [phone] C-1 111)
Fax Number: [phone]
Email Address: [e-mail]
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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.
Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-02
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