2017-02-10_REPORT - M1992009

• Permit No: M1992009
• IBM Index Class Name: REPORT
• Doc Date: 2/10/2017
• Doc Name: Annual Fee/Report/Map
• From: Gillette Sand and Gravel, Inc.
• To: DRMS
• Annual Report Year: 2017
• Email Name: ERR
• 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: V. C. Pyles
Permittee Company: Gillette Sand and Gravel, Inc.
Address: 20575 Hwy 24
Woodland Park,CO 80863
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: V. C.Pyles
Company: Gillette Sand and Gravel, Inc.
Address: 20575 Hwy 24
Woodland Park, CO 80863
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: V. C.Pyles
Company: Gillette Sand and Gravel,Inc.
Address: 20575 Hwy 24
Woodland Park, CO 80863
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
I,the un rsigned,hereby state that the information provided in this report is true and accurate, and that site operations are
being o ducted in accordance with the Division approved mining and reclamation plans.
Z-j--/7
gnature of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-01