2016-03-18_REPORT - M1978283

• Permit No: M1978283
• IBM Index Class Name: Report
• Doc Date: 3/18/2016
• Doc Name: Annual Fee, Report and Map
• From: Walsenburg Sand & Gravel Co.,
• To: DRMS
• Annual Report Year: 2016
• Email Name: TOD
• 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:
Louis Vezzani
Permittee Company:
Walsenburg Sand & Gravel Co.,
Inc.
Address:
P.O. Drawer 352
Walsenburg, CO 81089
Phone Number:
[phone]
Fax Number:
[phone]
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.
l
Signature of Permittee, Corporate Office-' Y'
M -AF -01
ner, or Documented Designee
Date