2017-11-15_REPORT - M2008060

• Permit No: M2008060
• IBM Index Class Name: REPORT
• Doc Date: 11/15/2017
• Doc Name: Annual Fee/Report/Map
• From: CLG Farms LLC
• To: DRMS
• Annual Report Year: 2017
• Email Name: ECS
• Media Type: D
• Archive: No

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'1'erniitteeCompany: CLGFarms,LLC
Address: 37951 Highway 34
Otis, CO 80743
Phone Number: [phone]
Fax Number:
Email Address:
Permitting Contact: Kelly S.Hansen
Company: Hansen Law LLC
Address: 117 Main Avenue
P.O. Box 400
Akron,CO 80720
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Chester W. Gebauer
Company: CLG Farms, LLC
Address: 37951 Highway 34
Otis, CO 80743
Phone Number: [phone]
Fax Number:
Email Address:
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.
a/4/14). * 01/44/4,1) it 1/
Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-0 1