2017-10-16_REPORT - M2003073

• Permit No: M2003073
• IBM Index Class Name: REPORT
• Doc Date: 10/16/2017
• Doc Name: Annual Fee/Report/Map
• From: Moffat Limestone
• To: DRMS
• Annual Report Year: 2017
• Email Name: ACY
• Media Type: D
• Archive: No

Page 5 of 5
Division records indicate the following penmitteeilandowner 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: Mike T.and Mardi F.Anson
Permittee Company: Moffat Limestone Company
Address: P.O. Box 363
Craig, CO 81626
Phone Number: [phone]
Fax Number: [phone]
Email Address: Moffatlimestone(cyahoo.com
Permitting Contact: Michael T.Anson
Company: Moffat Limestone Company
Address: P O Box 777
Craig,CO 81626
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: Michael T.Anson
Company: Moffat Limestone Company
Address: P O Box 777
Craig, CO 81626
Phone Number: [phone]
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.
Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-01