2017-11-14_REPORT - M1995017

• Permit No: M1995017
• IBM Index Class Name: Report
• Doc Date: 11/14/2017
• Doc Name: Annual Fee/Report/Map
• From: City of Sterling
• To: DRMS
• Annual Report Year: 2017
• Email Name: JLE
• 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:
Don Saling
Permittee Company:
City of Sterling
Address:
421 N. 4th Street
P O Box 4000
Sterling, CO 80751
Phone Number:
[phone]
Fax Number:
[phone]
Email Address:
[e-mail]
Permitting Contact:
Don Saling
Company:
City of Sterling
Address:
421 N. 4th Street
P O Box 4000
Sterling, CO 00000
Phone Number:
[phone]
Fax Number:
[phone]
Email Address:
[e-mail]
Inspection Contact:
Don Saling
Company:
City of Sterling
Address:
421 N. 4th Street
P O Box 4000
Sterling, CO 00000
Phone Number:
(970) 522-970U—
Fax Number:
[phone]
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 conducted in accordance with the Division approved mining and reclamation plans.
U 9474` _
Signature of Permittee Corporate Officer caner, or Documented Designee Date
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