2017-12-18_REPORT - M1979158

• Permit No: M1979158
• IBM Index Class Name: REPORT
• Doc Date: 12/18/2017
• Doc Name: Annual Fee/Report/Map
• From: Colorado City Metro Dist.
• To: DRMS
• Annual Report Year: 2017
• Email Name: ERR
• 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: David Valdez
Permittee Company: Colorado City Metropolitan
District
Address: 4497 Bent Brothers Blvd.
P.O. Box 20229
Colorado City, CO 81019
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: David Valdez
Company: Colorado City Metropolitan
District
Address: 4497 Bent Brothers Blvd.
P.O. Box 20229
Colorado City, CO 81019
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Inspection Contact: David Valdez
Company: Colorado City Metropolitan
District
Address: 4497 Bent Brothers Blvd.
P.O. Box 20229
Colorado City, CO 81019
Phone Number: [phone]
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.
9-'0 142-
Signature of Permittee Cor ,fficer,Owner,or Documented Designee Date
M-AF-04