2017-08-07_REPORT - M1999076

• Permit No: M1999076
• IBM Index Class Name: REPORT
• Doc Date: 8/7/2017
• Doc Name: Annual Fee/Report/Map
• From: Elam Construction, Inc.
• To: DRMS
• Annual Report Year: 2016
• Email Name: SJM
• 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: Jon Mueller
Permittee Company: Elam Construction, Inc.
Address: 556 Struthers Ave
Grand Junction, CO 81501-3826
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: John R.Elam
Company: Elam Construction, Inc.
Address: 556 Struthers Ave
Grand Junction, CO 81501
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Jon Mueller
Company: Elam Construction, Inc.
Address: 556 Struthers Ave
Grand Junction, CO 81501-3826
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 c atjW with the Division approved mining and reclamation plans.
Signature of ermittee Cor ,rate fficer,Owner,or Documented Designee Date
M-AF-OI