2017-08-07_REPORT - M1987044

• Permit No: M1987044
• IBM Index Class Name: REPORT
• Doc Date: 8/7/2017
• Doc Name: Annual Fee/Report/Map
• From: Elam Construction, Inc. dba Sandco, Inc.
• 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: Russ Larsen
Permittee Company: Elam Construction, Inc. dba
Sandco, Inc.
Address: 556 Struthers Ave.
Grand Junction, CO 81501-
3826
Phone Number: [phone]
Fax Number:
Email Address:
Permitting Contact:
Company:
Address:
Phone Number:
Fax Number:
Email Address:
Inspection Contact: Jon Mueller
Company: Elam Construction, Inc.
Address: 556 Struthers Ave.
Grand Junction, CO 81501-
3826
Phone Number:
Fax Number:
Email Address:
I,the undersigned,hereby state that the information pr 'ded in this report is true and accurate, and that site operations are
being conducted in accordance th the D' ' ' n ap ove mining and reclamation plans.
. Af J vzl-
Signature of Permit 'Corporate Offs r,Owner,or Documented Designee Date
M-AF-01