2017-11-21_REPORT - M1978039HR

• Permit No: M1978039HR
• IBM Index Class Name: REPORT
• Doc Date: 11/21/2017
• Doc Name: Annual Fee/Report/Map
• From: Pinon Ridge Mining LLC
• To: DRMS
• Annual Report Year: 2017
• Email Name: LJW
• Media Type: D
• Archive: No

Page 5 of 5
Division records indicate the loilowing permitteeilandowner contact information(blank Yields 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: George Glasier
Permittee Company: Pinon Ridge Mining LLC
Address: P 0 Box 825
31161 Highway 90
Nucla, CO 81424
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Permitting Contact: George Glasier
Company: Pinon Ridge Mining LLC
Address: P 0 Box 825
31161 Highway 90
Nucla, CO 81424
Phone Number:
Fax Number:
Email Address: [e-mail]
Inspection Contact: George Glasier
Company: Pinon Ridge Mining LLC
Address: P 0 Box 825
31161 HIghway 90
Nucla, CO 81424
Phone Number: [phone]
Fax Number:
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.
_ 4,_ Nod/0042a,
Signature of Permiyee,Corporate Officer,Owner,or Documented Designee Date
M-AF-02