2017-01-26_REPORT - M1994027

• Permit No: M1994027
• IBM Index Class Name: Report
• Doc Date: 1/26/2017
• Doc Name: Annual Fee/Report/Map
• From: Aggregate Industries - WCR, Inc.
• To: DRMS
• Annual Report Year: 2016
• 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: Connie N.Davis
Permittee Company: Aggregate Industries-WCR,
Inc.
Address: 1687 Cole Blvd., Ste. 300
Golden,CO 80401
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Michael C.Refer Connie N. Davis
Company: Aggregate Industries-WCR,
Inc.
Address: 1707 Cole Blvd., Ste. 100 1687 Cole Blvd., Suite 300
Golden,CO 80401-3220 Golden, CO 80401
Phone Number: [phone] [phone]
Fax Number: [phone]
Email Address:
[e-mail]
Inspection Contact: Michael C.Refer
Connie N. Davis
Company: Aggregate Industries-WCR,
Inc.
Address: 1687 Cole Blvd., Ste. 300 1687 Cole Blvd., Suite 300
Golden,CO 80401-3220 Golden, CO 80401
Phone Number: [phone] [phone]
Fax Number: [phone]
Email Address: [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.
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Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date
WAF-01