2016-02-09_REPORT - M1992009

• Permit No: M1992009
• IBM Index Class Name: Report
• Doc Date: 2/9/2016
• Doc Name: Annual Fee, Report & Map
• From: Gillette Sand and Gravel, Inc.
• To: DRMS
• Annual Report Year: 2016
• Email Name: TC1
• 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: V. C.Pyles
Permittee Company: Gillette Sand and Gravel, Inc.
Address: 20575 Hwy 24
Woodland Park,CO 80863
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 Vtedr ith the Division approved mining and reclamation plans.
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Sign tur ermittee, Corporate Officer,Owner,or Documented Designee Date
M-AF-01