2017-01-01_REPORT - M1984041

• Permit No: M1984041
• IBM Index Class Name: Report
• Doc Date: 1/1/2017
• Doc Name: Annual Fee/Report/Map
• From: American Gypsum Company LLC
• To: DRMS
• Annual Report Year: 2016
• Email Name: THM
• 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:
Jared D. Rhea
i
Permittee Company:
American Gypsum Company
LLC
Address:
740 Hwy 6
PO Box 980
Gypsum, CO 81637
Phone Number:
-
W
� � 3 Ll (OSFax
Number:
[phone]
Email Address:
[e-mail]
Permitting Contact:
Company:
American Gypsum Company
LLC
Address:
W40._IIwy-6--
-4q D 4w`
CD' Scx� CO Bq(p
Phone Number:
T
Fax Number:
[phone]
Email Address:
�Nk.
Inspection Contact:
Company:
American Gypsum Company
LLC
Address:
dwyG
LAC)
Wy� C-0 51(4137—
1(477—
Phone
Phone Number:
3r�
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 thWivision approved mining and reclamation plans.
Signature of
M -Ar -O]
Owner, or Documented Designee
/ Z- /'?
3 6
Dat