2017-10-06_REPORT - M2006027

• Permit No: M2006027
• IBM Index Class Name: REPORT
• Doc Date: 10/6/2017
• Doc Name: Annual Fee/Report/Map
• From: Dirt Merchant, Inc
• 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: Brian Wells
Permittee Company: Dirt Merchant, Inc.
Address: 638 1800 Road
Delta, CO 81416
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Brian Wells
Company: Dirt Merchant, Inc.
Address: 638 1800 Road
Delta, CO 81416
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact:
Company:
Address:
Phone Number:
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.
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Signature of Permittee, Corporate Officer,Owner,or Documented Designee Date
M-AF-01