2015-09-17_REPORT - M1976018

• Permit No: M1976018
• IBM Index Class Name: REPORT
• Doc Date: 9/17/2015
• Doc Name: Annual Fee, Report and Map
• From: North Weld Gravel
• To: DRMS
• Email Name: PSH
• 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:
Leroy A. Bellmore
Permittee Company:
North Weld Gravel
Address:
13480 WCR 100
Nunn, CO 80648-9700
Phone Number:
[phone]
Fax Number:
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.
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Signature of P rmittee `Cor orate Officer wne , or Documented Designee D4
M -AF -01