2017-07-19_REPORT - M1982090

• Permit No: M1982090
• IBM Index Class Name: REPORT
• Doc Date: 7/19/2017
• Doc Name: Annual Fee/Report/Map
• From: Camp Bird Colorado
• To: DRMS
• Annual Report Year: 2015
• Email Name: THM
• 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: Duane H.Gillman,Esq.
Permittee Company: Camp Bird Colorado, Inc.
Address: C/o Durham Jones&Pinegar,
P.C.
11 l East Broadway, Ste. 900 PO
Box 4050
Salt Lake City, UT 84110-4050
Phone Number: [phone]
Fax Number: (801)41 5-3500
Email Address: [e-mail]
Permitting Contact: Scott A.Butters Duane H Gillman Esq.
Company: Camp Bird Colorado,Inc. Camp Bird Colorado Inc.
Address: P.O. Box 806 c/o Durham Jones Pinegar P.C.
Salt Lake City, UT 84110 111 East Broadway,Ste.900
PO Box 4050
Salt Lake City LIT 84110-4050
Phone Number: [phone]
[phone]
Fax Number: [phone]
Email Address: Dgillman@djplaw com
Inspection Contact: Scott A.Butters
Duane H Gillman Esq.
Company: Camp Bird Colorado, Inc.
Camp Bird Colorado Inc.
Address: P.O. Box 806 c/o Durham Jones Pinegar P.C.
Salt Lake City, UT 84110
PO Box 4050
Salt Lake City LIT 84110-4050
Phone Number: [phone]
[phone]
Fax Number: [phone]
Email Address: Dgillman@djplaw com
I,the undersigned, ereby state that the i tion provided in this report is true and accurate,and that site operations are
being conducted . accordance ith th i on approved mining and reclamation plans.
�► July, 17, 2017
Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date
M•AF-02