2017-01-10_REPORT - M2012050

• Permit No: M2012050
• IBM Index Class Name: REPORT
• Doc Date: 1/10/2017
• Doc Name: Annual Fee/Report/Map
• From: Oldcastle SW Group
• To: DRMS
• Annual Report Year: 2017
• Email Name: SJM
• 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: Jason Burkey
Permittee Company: Oldcastle SW Group, Inc. dba United
Companies of Mesa County
Address: 2273 River Road
P O Box 3609
Grand Junction,CO 81502
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact:
Company:
Address:
Phone Number:
Fax Number:
Email Address:
Inspection Contact: Jason Burkey
Company: Oldcastle SW Group
Address: 2273 River Road
PO Box 3609
Grand Junction, CO 81502
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.
2017
Signature of Per " ee,Corporate Officer.Owner.or Documented Designee Date
M-AF-04