2017-09-20_REPORT - M1977170

• Permit No: M1977170
• IBM Index Class Name: REPORT
• Doc Date: 9/20/2017
• Doc Name: Annual Fee/Report/Map
• From: Butala Construction
• To: DRMS
• Annual Report Year: 2016
• Email Name: DMC
• 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: Thomas M.Eve
Permittee Company: Butala Construction Company
Address: 9000 CR 152
P.O.Box 907
Salida,CO 81201-9519
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: Thomas M.Eve
Company: Butala Construction Company
Address: 9000 CR 152
P.O. Box 907
Salida,CO 81201-9519
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: Thomas M.Eve
Company: Butala Construction Company
Address: 9000 CR 152
P.O. Box 907
Salida,CO 81201-9519
Phone Number: [phone]
Fax Number:
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.
L -
//y/- 4- " 1 // � ?
Signature of Permittee,Corporate Officer,Owner,or Documented Designee Da
M-AF-01