2017-01-19_REPORT - M2007058

• Permit No: M2007058
• IBM Index Class Name: REPORT
• Doc Date: 1/19/2017
• Doc Name: Annual Fee/Report/Map
• From: C&B Sand & Gravel, Inc.
• To: DRMS
• Annual Report Year: 2017
• Email Name: ACY
• 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: Donald Corson
Permittee Company: C&B Sand and Gravel Inc.
Address: P.O. Box 147
Baggs, WY 82321
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
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Permitting Contact: Donald R.Corson
Company: C&B Sand and Gravel,Inc.
Address: PO Box 147
Baggs , WY 82321
Phone Number: [phone]
Fax Number:
Email Address: Dnr—[e-mail]
Inspection Contact: Donald Corson
Company: C&B Sand and Gravel, Inc.
Address: PO Box 147
Baggs, WY 82321
Phone Number: [phone]
Fax Number:
Email Address: Dnr—[e-mail]
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.
Signaglire of Permittee,Corporate Officer,Owner,or Documented Desienee Date
M-AF-01