2017-10-24_REPORT - M2009002

• Permit No: M2009002
• IBM Index Class Name: REPORT
• Doc Date: 10/24/2017
• Doc Name: Annual Fee/Report/Map
• From: Baca County
• To: DRMS
• Annual Report Year: 2017
• Email Name: MAC
• Media Type: D
• Archive: No

a�ei�aa�MUMmii Tits® sunwerUM.a®W-VOMeMAW _ --
T7'�aireeCa�r i - UNOW
1"tannt�eeC.om,Q�y. [�■�a�,e■�r. ,
Address:_ - 741 Main St.,Suite 1
Springfield, CO 8-1073
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Peter L.Dawson
Company: Baca County Government
Address: 741 Main St.
Springfield,CO 81073
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Peter L.Dawson
Company: Baca County Government
Address: 741 Main St.
Springfield, CO 81073
Phone Number: [phone]
Fax Number: [phone]
Email Address: // �✓
S&V a WO UN
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.
/,,-Z /7�L (
Signature of Permtttee, orporate Officer,Owner,or Documented Designee ate
M-AF-04