2016-10-14_M1982090_Annual Fee Notice ARCHIVE

• Permit No: M1982090A
• IBM Index Class Name: Report
• Doc Date: 10/14/2016
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Camp Bird Colorado, Inc.
• Annual Report Year: 2016
• Media Type: D
• Archive: Yes

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:

Duane H. Gillman, Esq.
Permittee Company:

Camp Bird Colorado, Inc.
Address:

C/o Durham Jones & Pinegar,
P.C.
111 East Broadway, Ste. 900 PO
Box 4050
Salt Lake City, UT 84110-4050

Phone Number:

[phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact:

Scott A. Butters
Company:

Camp Bird Colorado, Inc.
Address:

P.O. Box 806
Salt Lake City, UT 84110

Phone Number:

[phone]
Fax Number:
Email Address:
Inspection Contact:

Scott A. Butters
Company:

Camp Bird Colorado, Inc.
Address:

P.O. Box 806
Salt Lake City, UT 84110

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.

Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date
M-AF-02