2017-10-30_REPORT - M2009069

• Permit No: M2009069
• IBM Index Class Name: REPORT
• Doc Date: 10/30/2017
• Doc Name: Annual Fee/Report/Map
• From: Yuma County
• To: DRMS
• Annual Report Year: 2017
• Email Name: ERR
• Media Type: D
• Archive: No

Allairaraker
aa•sMBNEan=Oak i$imsa■■®Eaaammara■r.easeaLareara ,
IPendiuee i.o `'V umaLooiri-
Address: 1310 S. Blake St.
Wray, CO 80758
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Don Man
Company: Yuma County
Address: 1310 S. Blake St.
Wray,CO 80758
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Inspection Contact: Don Mart-
Company:
arrCompany: Yuma County
Address: 1310 S. Blake St.
Wray, CO 80758
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
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.
/0 4 -(7
Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-04