2017-08-07_REPORT - M1986165

• Permit No: M1986165
• 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: Russell A. 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: Jon Mueller
Company: Elam Construction, Inc. dba
Sandco, Inc.
Address: 556 Struthers Ave.
Grand Junction, CO 81501-
3826
Phone Number: (97)024-2537
Fax Number: [phone]
Email Address:
Inspection Contact: Jon Mueller
Company: Elam Construction, Inc. dba
Sandco, Inc.
Address: 556 Struthers Ave.
Grand Junction, Co 81501-3826
Phone Number:
Fax Number:
Email Address:
I,the undersigned, hereby state that the infor tion provided in this report is true and accurate, and that site operations are
being conducted in accor ce e Di si n approved mining and reclamation plans.
Signature ermittee Cory- to Officer,Owner,or Documented Designee Date
M-AF-01