2017-11-02_REPORT - M2013028

• Permit No: M2013028
• IBM Index Class Name: Report
• Doc Date: 11/2/2017
• Doc Name: Annual Fee/Report/Map
• From: Western States Minerals, LLC
• To: DRMS
• Annual Report Year: 2017
• Email Name: MAC
• Media Type: D
• Archive: No

Page 5 of S
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:
Randy Burks
Permittee Company:
Western States Minerals,LLC
Address:
7964 E. Homestead Rd.
Parker, CO 80138
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Phone Number:
[phone]
Fax Number:
Email Address:
Permitting Contact:
Jeff Vogt
9 Yn C 0
Company:
Address:
1260 Eudora St.
Denver, CO 80220
Phone Number:
[phone]
Fax Number:
Email Address:
VogtI I @comcast.net
Inspection Contact:
Randy Burks
Company:
Western States Minerals,LLC
Address:
7964 E. Homestead Rd.
Parker, CO 80138
Phone Number:
[phone]
Fax Number:
Email Address:
Asbstacker@aaLcoFn—
;.
I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site o ra ions% e, rL.
being Onducted in accordance with the Division approved mining and reclamation plans.
Permittee Corporate Officer, Owner, or Documented Desianee
M -AF -0: