2017-03-21_REPORT - M1977572

• Permit No: M1977572
• IBM Index Class Name: REPORT
• Doc Date: 3/21/2017
• Doc Name: Annual Fee/Report/Map
• From: City of Lamar
• To: DRMS
• Annual Report Year: 2017
• Email Name: AME
• 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: John R. Sutherland,Jr.
Permittee Company: City of Lamar
Address: 102 East Parmenter
Lamar,CO 81052
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Permitting Contact: John R. Sutherland,Jr.
Company: City of Lamar
Address: 102 East Parmenter
Lamar,CO 81052
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: John R. Sutherland,Jr.
Company: City of Lamar
Address: 102 East Parmenter
Lamar,CO 81052
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 accordance with the Division approved mining and reclamation plans.
03. I4. ZD17
Signature oflPermittee,Corporate OfficeK\,i2wner,or Documented Designee Date
M-AF-04