2017-12-29_REPORT - M1998080

• Permit No: M1998080
• IBM Index Class Name: REPORT
• Doc Date: 12/29/2017
• Doc Name: Annual Fee/Report/Map
• From: H&H Stone
• To: DRMS
• Annual Report Year: 2017
• Email Name: LJW
• Media Type: D
• Archive: No

Paws 605
Division records indicate the following pernittee/iandowner contact information(blank fields indicate that we do"hate
information on record). Sthis information is blank or not current,please type or print a�nrat contact infer
i�
Address: P.O. Box 246
Dove Creek,CO 81324
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: o ey,, l /
Company: H& H Stone
Address: P. O. Box 246
Dove Creek, CO 81324
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Inspection Contact: -Be 4,uegeq--
Company: H&H Stone
Address: P.O. Box 246
Dove Creek, CO 81324
Phone Number: [phone]
Fax Number: [phone]
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 con cted in accordance with the Division approved mining and reclamation plans.
M
/0?/ Q/� j/--)
S n re of Permittee, Corporate Officer,Olyner,or Documented Designee D e
M-AF-01