2015-08-25_REPORT - M2005061

• Permit No: M2005061
• IBM Index Class Name: Report
• Doc Date: 8/25/2015
• Doc Name: Annual Fee/Report/Map
• From: M.A. Concrete Construction
• To: DRMS
• Email Name: SJM
• 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:
MartinAzcarraga
Permittee Company:
M.A. Concrete Construction,
Inc.
Address:
2323 River Road
Grand Junction, CO81505
Phone Number:
[phone]
Fax Number:
Email Address:
[e-mail]
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.
Signature ofPermittee, Corporate Officer, Owner, or Documented Designee Date
MOM