2017-10-23_REPORT - M1983187

• Permit No: M1983187
• IBM Index Class Name: REPORT
• Doc Date: 10/23/2017
• Doc Name: Annual Fee/Report/Map
• From: Logan County
• To: DRMS
• Annual Report Year: 2017
• Email Name: JLE
• Media Type: D
• Archive: No

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information on record). If this information is blank or not current,please type or Print current contact information:
Yerrn itwe Comte I
Permittee Company: Logan County
Address: 315 Main St., Ste. 2
Sterling, CO 80751
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Rob Quint
Company: Logan County
Address: 315 Main St., Ste. 2
Sterling,CO 80751
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Chad Wright
Company: Logan County
Address: 12603 CR 33
Sterling,CO 80751
Phone Number: [phone]
Fax Number: [phone]
Email Address:
I,the undersigned,hereby site that the information provided in this report is true and accurate,and that site operations are
being conducted in accor ante wi the Division approved mining and reclamation plans.
Signature of Permittee, orporate Officer,Owner,or Documented Designee Date
M-AF-04