2015-09-01_REPORT - M1997026

• Permit No: M1997026
• IBM Index Class Name: REPORT
• Doc Date: 9/1/2015
• Doc Name: Annual Fee, Report & Map
• From: Oldcastle SW Group
• To: DRMS
• Email Name: THM
• Media Type: D
• Archive: No

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Division records indicate the following permittee contact information. If this information is not current, please type or
print current contact information:
Permittee Contact:
JasonBurkey
Permittee Company:
Oldcastle SW Group, Inc. dba B
& B Excavating
Address:
P.O. Box 3609
Grand Junction, C081502-3609
Phone Number:
[phone]
Fax Number:
[phone]
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.
?/.2 -s%
Signature ofPermitt�, Corporate Officer, Owner, or Documented Designee Date
M -AF -01