2015-09-15_REPORT - M1980205

• Permit No: M1980205
• IBM Index Class Name: REPORT
• Doc Date: 9/15/2015
• Doc Name: Annual Fee, Report & Map
• From: Select Materials
• To: DRMS
• Email Name: PSH
• 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:
Robert D. Oman
Permittee Company:
lect Materials, LLC
Address:
P.O.x 280
Fort Lupton, CO 80621
Phone Number:
[phone]
Fax Number:
[phone]
Email Address:
[e-mail]
I, the undersigned, hereby state that t 'information provided int report is true and accurate, and that site operations are
being conducted in accordance wit he Division approved mining an reclamation plans.
Signature of
M -AF -01
Owner, or
Date