2015-08-31_REPORT - M1986105

• Permit No: M1986105
• IBM Index Class Name: REPORT
• Doc Date: 8/31/2015
• Doc Name: Annual Fee, Report & Map
• From: Dilley's Sand & Gravel
• To: DRMS
• Email Name: ECS
• 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:
Vernon Dilley
Permittee Company:
Dilleys Sand & Gravel
Address:
1914 Edmunds St.
P.O. Box 125
Brush, CO 80723
Phone Number:
[phone]
Fax Number:
[phone]
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.
Signature of
M -AF -01
Owner, or Documented Desisnee
Date