2017-12-04_REPORT - M1980239

• Permit No: M1980239
• IBM Index Class Name: REPORT
• Doc Date: 12/4/2017
• Doc Name: Annual Fee/Report/Map
• From: Moffat County
• To: DRMS
• Annual Report Year: 2017
• Email Name: ACY
• 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: Dan Miller
Permittee Company: Moffat County
Address: P.O.Box 667
Craig,CO 81626
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact:
Company:
Address:
Phone Number:
Fax Number:
Email Address:
Inspection Contact: Dan Miller
Company: Moffat County
Address: P.O.Box 667
Craig,CO 81626
Phone Number: [phone]
Fax Number: [phone]
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' dance with the Division approved mining and reclamation plans.
11/28/2017
Signature o Permittee.Corporate Officer,Owner,or Documented Designee Date
M AF-04