2017-06-26_REPORT - M2000030

• Permit No: M2000030
• IBM Index Class Name: REPORT
• Doc Date: 6/26/2017
• Doc Name: Annual Fee/Report/Map
• From: Elam Consruction
• To: DRMS
• Annual Report Year: 2016
• 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: Russell A. Larsen
Permittee Company: Elam Construction, Inc.
Address: 556 Struthers Ave
Grand Junction, CO 81501-
3826
Phone Number: [phone]
Fax Number:
Email Address:
Permitting Contact: John R. Elam
Company: Elam Construction, Inc.
Address: 556 Struthers Ave
Grand Junction, CO 81501
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: Jon Mueller
Company: Elam Construction, Inc.
Address: 556 Struthers Ave
Grand Junction, CO 81501-
3826
Phone Number: [phone]
Fax Number:
Email Address:
I,the undersigned,hereby state that the information provided in this report is true and accurate, and that site operations are
being c ed in accordant with the Division approved mining and reclamation plans.
Signature o ermittee Cor ,ra a fficer,Owner,or Documented Designee Date
M-AF-01