2016-12-15_REPORT - M2010062

• Permit No: M2010062
• IBM Index Class Name: REPORT
• Doc Date: 12/15/2016
• Doc Name: Annual Fee/Report/Map
• From: White Sand Gravel Pit #1
• To: DRMS
• Annual Report Year: 2016
• Email Name: AME
• 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: Tim White
Permittee Company: White Sand&Gravel,LLC
Address: 7 N St Road
Box 806
Elkhart,KS 67950
Phone Number: [phone] 44 d t- (p-,;0 --34D —03/�
Fax Number:
Email Address: [e-mail] o—b ke-rrocl el k�-;A ,Corn
Permitting Contact: Tim White
Company: White Sand&Gravel,LLC
Address: 7 N St Road
Box 806
Elkhart,KS 67950
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: Tim White
Company: White Sand&Gravel,LLC
Address: 7 N St Road
Box 806
Elkhart,KS 67950
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 conducted in accordance with the Division approved mining and reclamation plans.
f /D
Signature of Permittee.Cort orate Officer,Owner,or Documented Designee Date
M-AF-01