2017-03-29_REPORT - M2009053

• Permit No: M2009053
• IBM Index Class Name: REPORT
• Doc Date: 3/29/2017
• Doc Name: Annual Fee/Report/Map
• From: Robins Construction, LLLP
• To: DRMS
• Annual Report Year: 2017
• Email Name: DMC
• 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: Randy Robins
Permittee Company: Robins Construction,LLLP
Address: P.O. Box 212
Antonito, CO 81120
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Scott E.Johnson
Company: Summit Engineering Company
Address: P.O. Box 1897
Alamosa, CO 81101
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Randy Robins
Company: Robins Construction,LLLP
Address: P.O. Box 212
Antonito, CO 81120
Phone Number: [phone]
Fax Number: [phone]
Email Address:
1,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.
u 3/-z 7
Signature of Peridittee,Corporate Officer,Owner,or Documented Desiznee Date
M-AF-01