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:
Select Materials, LLC
Address:
P.O. Box 280
Fort Lupton, CO 80621
Phone Number:
[phone]
Fax Number:
[phone]
Email Address:
Bob(a�selectmaterials.net
I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are
being co ducted in accordance wth the Division approved mining and reclamation plans.
Signature of Permittee, Corporate Officer, Owner, or Documented Designee
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