2017-01-12_REPORT - M1979187

• Permit No: M1979187
• IBM Index Class Name: Report
• Doc Date: 1/12/2017
• Doc Name: Annual Fee/Report/Map
• From: Everist Materials, LLC
• To: DRMS
• Annual Report Year: 2017
• Email Name: PSH
• 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:
Mahlon Dysart
Permittee Company:
Everist Materials, LLC
Address:
P.O. Box 1150
28755 Highway 9
Silverthorne, CO 80498
Phone Number:
[phone]
Fax Number:
Email Address:
[e-mail]
Permitting Contact:
or
Company:
Everist Materials, LLC
Address:
P.O. Box 1150
28755 Highway 9
Silverthorne, CO 80498
Phone Number:
[phone]
Fax Number:
Email Address:
C-ftTNVrWick-
Inspection Contact:
Company:
Everist Materials, LLC
Address:
P.O. Box 1150
28755 Highway 9
Silverthorne, CO 80498
Phone Number:
[phone]
Fax Number:
Email Address:
1, 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.
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Signature of Permittee. VarnAnte Officer, Owner, or Documented Desisnee Date
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