2016-12-20_REPORT - M1985200

• Permit No: M1985200
• IBM Index Class Name: REPORT
• Doc Date: 12/20/2016
• Doc Name: Annual Fee/Report/Map
• From: Erker Estates, Ltd.
• To: DRMS
• Annual Report Year: 2016
• Email Name: ECS
• 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: Nicholas E.Erker
Permittee Company: Erker Estates Ltd.
Address: 511 Grant Street
Fort Morgan, CO 80701
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Permitting Contact: Nicholas E.Erker
Company: ErkerEstates Ltd.
Address: 511 Grant Street
Fort Morgan,CO 80701
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: Nicholas E.Frker
Company: ErkerEstates Ltd.
Address: 511 Grant Street
Fort Morgan, CO 80701
Phone Number: [phone]
Fax Number:
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 conducted in accord ith the Division approved mining and reclamation plans.
LLD)�
Signa a of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-04