2016-12-13_REPORT - M1996060

• Permit No: M1996060
• IBM Index Class Name: REPORT
• Doc Date: 12/13/2016
• Doc Name: Annual Fee/Report/Map
• From: Bestway Concrete
• 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: Mark Johnson
Permittee Company: Bestway Concrete Company
Address: 301 Centennial Dr.
Milliken, CO 80543
Phone Number: [phone]
Fax Number: [phone]
Email Address: ® L4&-.
Permitting Contact: Mark Johnson
Company: Bestway Concrete Company
Address: 301 Centennial Dr.
Milliken, CO 80543
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Mark Johnson
Company: Bestway Concrete Company
Address: 301 Centennial Dr.
Milliken, CO 80543
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.
i r L0/t
Signature of Permittee, torporate Officer,Owner,or Documented Designee Date
M-AF-O I