2015-07-06_REPORT - M2009024

• Permit No: M2009024
• IBM Index Class Name: REPORT
• Doc Date: 7/6/2015
• Doc Name: Annual Fee, Report and Map
• From: Oldcastle SW Group, Inc. dba Four Corners Materials
• To: DRMS
• Email Name: LJW
• Media Type: D
• Archive: No

Page 5 of 5
Division records indicate the following permittee contact information. If this information is not current, please type or
print current contact information:
Permittee Contact:
MattCarnahan
Permittee Company:
Oldcastle SW Group, Inc. dba
Four Corners Materials
Address:
P.O. Box 1969
Bayfield, C081122-1969
Phone Number:
[phone]
Fax Number:
[phone]
Email Address:
mG2✓n-, e,4-co✓riev-S nj
a.(-wr215.00'Y1
I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are
being conducted ;n accordance with the Division approved mining and reclamation plans.
Signature
M -AF -01
C, ' 06 2g 1—s
Corporate Officer, Owner, or Documented Designee Da e