2016-12-16_REPORT - M1974015

• Permit No: M1974015
• IBM Index Class Name: Report
• Doc Date: 12/16/2016
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Martin Marietta Materials, Inc.
• Annual Report Year: 2017
• 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:

Julie Mikulas
Permittee Company:

Martin Marietta Materials, Inc.
Address:

1800 N. Taft Hill Road
Fort Collins, CO 80521

Phone Number:

[phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact:

Julie Mikulas
Company:

Martin Marietta Materials, Inc.
Address:

1800 N. Taft Hill Road
Fort Collins, CO 80521

Phone Number:

[phone]
Fax Number: [phone]
Email Address:
Inspection Contact:

Julie Mikulas
Company:

Martin Marietta Materials, Inc.
Address:

1800 N. Taft Hill Road
Fort Collins, CO 80521

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.

Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date
M-AF-01