2017-04-21_REPORT - M1991133

• Permit No: M1991133
• IBM Index Class Name: REPORT
• Doc Date: 4/21/2017
• Doc Name: Annual Fee/Report/Map
• From: Robins Construction, LLLP
• To: DRMS
• 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:
Email Address: [e-mail]
Permitting Contact: Randy Robins
Company: Robins Construction,LLLP
Address: P O Box 212
Antonito,CO 81120
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: Randy Robins
Company: Robins Construction,LLLP
Address: P O Box 212
Antonito,CO 81120
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.
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ignature of Pe ittee Corporate Officer,Owner,or Documented Designee Date
M-AF-01