2017-01-31_REPORT - M2007005

• Permit No: M2007005
• IBM Index Class Name: REPORT
• Doc Date: 1/31/2017
• Doc Name: Annual Fee/Report/Map
• From: City of Grand Junction
• 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: Jerod Timothy
Permittee Company: City of Grand Junction
Address: 250 N 5th Street
Grand Junction, CO 81501
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact:
Company: City of Grand Junction
Address: 250 North 5th Street
Grand Junction, CO 81501
Phone Number: - ?o 244— 14 6J!
Fax Number: [phone]
Email Address:
Inspection Contact: JAw . a
Company: City of Grand Junction
Address: 250 North 5th Street
Grand Junction, CO 81501
Phone Number: (970) 3— ��70�-Zi-4- r5 4-5
Fax Number: [phone]
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 90 mittee.Cor orate Officer,Own ,or Documented DesiEnee D to
M-AF-04