2017-01-26_REPORT - M1992069

• Permit No: M1992069
• 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: 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: 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: 99 9 connie.davis@ a re ate-us.com
Inspection Contact: Michael C. Refer Connie N. Davis
Company: Aggregate Industries-WCR,
Inc.
Address: 1687 Cole Blvd., Ste. 300
Golden,CO 80401-3220
Phone Number: [phone] [phone]
Fax Number: [phone]
Email Address: [e-mail]
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.
Signature of Permittee,Corporate Officer, Owner,or Documented Designee Date
M-AF-01 �-