2017-09-22_REPORT - M1981068

• Permit No: M1981068
• IBM Index Class Name: REPORT
• Doc Date: 9/22/2017
• Doc Name: Annual Fee/Report/Map
• From: Grant Bros Construction Ltd
• To: DRMS
• Annual Report Year: 2016
• Email Name: GRM
• 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: Dan or Doug Grant
Permittee Company: Grant Bros Construction Ltd
Address: P.O. Box 1027
Basalt, CO 81621
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: Dan Doug
Company: Grant Bros Construction Ltd
Address: P.O. Box 1027
Basalt, CO 81621
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: Dan Doug
Company: Grant Bros Construction Ltd
Address: P.O. Box 1027
Basalt, CO 81621
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
be' cond ted in accord ce with the Division approved mining and reclamation plans.
Signature of Permittee,Corporate Officer,Owner,or Documented Designee ate
M-AF-01