2017-07-03_REPORT - M1996031

• Permit No: M1996031
• IBM Index Class Name: REPORT
• Doc Date: 7/3/2017
• Doc Name: Annual Fee/Report/Map
• From: Sutherland Bros.
• To: DRMS
• Annual Report Year: 2016
• 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: Bob Sutherland
Permittee Company: Sutherland Brothers, Inc.
Address: P.O. Box 889
Nucla,CO 81424
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Douglas L. Conger
Company:
Address: 711 Hartman Rd.
Cortez, CO 81321
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Bob Sutherland
Company: Sutherland Brothers,Inc.
Address: 29703 Hwy 97
P.O. Box 126
Nucla, CO 81424
Phone Number: (970)864-"Q
Fax Number: [phone]
Email Address:
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.
v
Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-01