2016-11-21_REPORT - M2014064

• Permit No: M2014064
• IBM Index Class Name: Report
• Doc Date: 11/21/2016
• Doc Name: Annual Fee/Report/Map
• From: VCA Aggregates LLC
• 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:
Sandy Van Cleave
Permittee Company:
VCA Aggregates LLC
Address:
4558 W Pioneer Ln
P.O. Box 336953
Greeley, CO 80633
Phone Number:
[phone]
Fax Number:
Email Address:
[e-mail]
1, 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.
of eP rmittee, Corporate Officer, Owner, or Documented Designee Da - e
M -AF -01