2017-01-05_REPORT - M1998084

• Permit No: M1998084
• IBM Index Class Name: Report
• Doc Date: 1/5/2017
• Doc Name: Annual Fee/Report/Map
• From: Grand Junction Pipe & Supply Co.
• To: DRMS
• Annual Report Year: 2017
• Email Name: SJM
• 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:
Russell A. Larsen
Permittee Company:
Grand Junction Pipe & Supply
Co.
556 Struthers Ave
Grand Junction, CO 81501-
3826
Address:
Phone Number:
[phone]
Fax Number:
[phone]
Email Address:
T
a
Permitting Contact:
Jon Mueller
Company:
Grand Junction Pipe & Supply
Co.
556 Struthers Ave
Grand Junction, CO 81502
Address:
Phone Number:
[phone]
...............
Fax Number:
[phone]
Email Address:
Inspection Contact:
SA^U, A$
Company:
Address:
Phone Number:
Fax Number:
Email Address:
I, the undersigned, hereby state that the informatio p vided in this report is true and accurate, and that site operations are
being conducted i cordance with the ivision prdved mining and reclamation plans.
)A At I
ao1�-
Signature of Per6iwe. Cor orate Officer Owner. or Documented Designee Date
M -AF a. 1