2016-11-30_REPORT - M1996049

• Permit No: M1996049
• IBM Index Class Name: REPORT
• Doc Date: 11/30/2016
• Doc Name: Annual Fee/Report/Map
• From: Everist Materials, 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/landowner contact information(blank fields indicate that we do not have
information on record). If this information is blank or not current,please type or print current contact information:
Permittee Contact: "-Aaieirzzsicr
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Permittee Company: Everist Materials, LLC
Address: P.O. Box 1150
Silverthorne, CO 80498
Phone Number: [phone]
Fax Number: [phone]
Email Address:
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Permitting Contact: Jeannaiiopkias
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Company: Maryland Creek Ranch
Address: P.O. Box 1609
Silverthorne, CO 80498
Phone Number: [phone]
Fax Number: [phone]
Email Address: m fM .jCi q ca-cj vj h-i a1 .C G iv)
Inspection Contact: EricB4nginek
Company: Everist Materials,LLC
Address: 28755 Highway 9
P.O. Box 1150
Silverthorne, CO 80498
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.
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Signature of Permittee,Corporate Officer,Owner,or Documented Designee hate
M-AF-01