2017-01-04_REPORT - M1984108

• Permit No: M1984108
• IBM Index Class Name: REPORT
• Doc Date: 1/4/2017
• Doc Name: Annual Fee/Report/Map
• From: Western Gravel, Inc.
• To: DRMS
• Annual Report Year: 2016
• Email Name: DMC
• 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: Judy DeVincentis
Permittee Company: Western Gravel, Inc.
Address: 3001 N. Townsend Ave.
Montrose, CO 81401
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact:
Company: Western Gravel, Inc.
Address: 3001 N. Townsend Ave.
Montrose, CO 81401
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact:
Company: Western Gravel, Inc. �l v
Address: 3001 N.Townsend Ave.
Montrose, CO 81401
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.
S' ature o rmittee, Corporate Officer,Owner,or Documented Designee at
-AF-01