2017-07-18_REPORT - M1998038

• Permit No: M1998038
• IBM Index Class Name: REPORT
• Doc Date: 7/18/2017
• Doc Name: Annual Fee/Report/Map
• From: Kirkland Construction
• To: DRMS
• Annual Report Year: 2016
• Email Name: ERR
• 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: ;oe-E-Bmitr ��,���( ,Nq
Permittee Company: Kirkland Construction, R.L.L.P.
Address: P.O. Box 580
Rye, CO 81069
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: James H.Kirkland
Company: Kirkland Construction,RLLP
Address: P.O. Box 580
2101 Main Street
Rye, CO 81069
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Baxter W.Kirkland
Company: Kirkland Construction,RLLP
Address: P.O. Box 580
2101 Main Street
Rye,CO 81069
Phone Number: [phone]
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.
i �' 9 71l6
Signature of Permittee Co rate Officer,Owner,or Documented Designee Date
M-AF-01