2017-10-11_REPORT - M2000077

• Permit No: M2000077
• IBM Index Class Name: REPORT
• Doc Date: 10/11/2017
• Doc Name: Annual Fee/Report/Map
• From: PK Enterprises
• 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: Bryan P.Johnson
Permittee Company: PK Enterprises, Inc.
Address: 11115 W. Hwy. 24, Unit 2A
P.O. Box 729
Divide, CO 80814
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Gregory A.Loop
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Company: PK Enterprises, Inc.
Address: 11115 W. Hwy. 24, Unit 2A
Divide, CO 80814
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Gregory A.Loop
Company: PK Enterprises, Inc.
Address: 11115 W.Hwy. 24,Unit 2A
P.O. Box 729
Divide, CO 80814
Phone Number: [phone]
Fax Number: [phone]
Email Address:
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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.
4—
Signature o rmittee Corporate Officer,Owner,or Documented Designee t
M-AF-01