2017-12-07_REPORT - M1983130

• Permit No: M1983130
• IBM Index Class Name: REPORT
• Doc Date: 12/7/2017
• Doc Name: Annual Fee/Report/Map
• From: Elbert County
• To: DRMS
• Annual Report Year: 2017
• Email Name: PSH
• 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: Kelly Moore
Permittee Company: Elbert County
Address: P.O. Box 116
Kiowa,CO 80117
Phone Number: [phone]
Fax Number: [phone]
Email Address: Kelly.moore@ELBERTCOUNTY-
CO.GOV
Permitting Contact: Robert Morrison
Company: Elbert County
Address: 215 Comanche St.
P.O.Box 597
Kiowa,CO 80117
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: Robert Morrison
Company: Elbert County
Address: 215 Comanche St.
P.O.Box 597
Kiowa,CO 80117
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.
alliK
Ea 1I —.20—(7
Signature of Permittee Cor orate Officer,Owner,o Documented Designee Date
M-AF-04