2016-12-08_REPORT - M2011028

• Permit No: M2011028
• IBM Index Class Name: REPORT
• Doc Date: 12/8/2016
• Doc Name: Annual Fee/Report/Map
• From: Olscastle SW Group
• To: DRMS
• Annual Report Year: 2016
• Email Name: LJW
• 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: Matt Carnahan
Permittee Company: Oldcastle SW Group, Inc. dba Four
Corners Materials
Address: P.O. Box 1969
Bayfield, CO 81122-1969
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Permitting Contact: Matt Carnahan
Company: Oldcastle SW Group, Inc. dba Four
Corners Materials
Address: 6699 County Road 521
Bayfield, CO 81122
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: Matt Carnahan
Company: Oldcastle SW Group, Inc. dba Four
Corners Materials
Address: 6699 County Road 521
Bayfield, CO 81122
Phone Number: [phone]
Fax Number:
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 condu ted in accordance with the Division approved mining and reclamation plans.
�U ff�\//COAMO[TAL SIC r2. I 30 2O16
Signature f Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-01