2017-10-19_REPORT - M1978066

• Permit No: M1978066
• IBM Index Class Name: REPORT
• Doc Date: 10/19/2017
• Doc Name: Annual Fee/Report/Map
• From: Rio Grande County
• To: DRMS
• Annual Report Year: 2017
• Email Name: THM
• 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: Patrick Sullivan
Permittee Company: Rio Grande County
Address: 168 N. Washington
Monte Vista, CO 81144
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Patrick Sullivan
Company: Rio Grande County
Address: 168 N. Washington
P.O.Box 46
Monte Vista, CO 81144
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: Patrick Sullivan
Company: Rio Grande County
Address: 168 N. Washington
P.O. Box 46
Monte Vista, CO 81144
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
1,the undersigned,hereby state that the information provided in this report is true and accurate, and that site operations are
being conduct n a cordance with the Division approved mining and reclamation plans.
/6 ex.T )7
Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-04