2016-03-01_REPORT - M2009006

• Permit No: M2009006
• IBM Index Class Name: REPORT
• Doc Date: 3/1/2016
• Doc Name: Annual Fee, Report & Map
• From: Meadow Hollow Quarry
• To: DRMS
• Annual Report Year: 2016
• Email Name: ECS
• 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:
Wayne Dorband
Permittee Company:
Colorado Quarry I, LLC
Address:
901 S. CR31
Berthoud, CO 80513
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.
Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date
M -AF -01