2017-04-04_REPORT - M2004063

• Permit No: M2004063
• IBM Index Class Name: REPORT
• Doc Date: 4/4/2017
• Doc Name: Annual Fee/Report/Map
• From: Hocker Construction, LLP
• To: DRMS
• Annual Report Year: 2017
• Email Name: LJW
• 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: Roy Hocker
Permittee Company: Hocker Construction,LLP
Address: P.O.Box 627
Ignacio,CO 81137
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: Kirk Allen
Company: Southwest Land Services,Inc.
Address:, 842 1/2 Main Ave.,Ste.200
P.O.Box 2673
Durango,CO 81301
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Roy Hocker
Company: Hocker Construction,LLP
Address: P O Box 627
Ignacio, CO 81137
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 condu in accordance with the Division approved mining and reclamation plans.
Signatur of PKermittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-01