2017-02-14_REPORT - M1983028

• Permit No: M1983028
• IBM Index Class Name: REPORT
• Doc Date: 2/14/2017
• Doc Name: Annual Fee/Report/Map
• From: Stone Sand & Gravel
• To: DRMS
• Annual Report Year: 2017
• Email Name: LJW
• 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: Kathy Stone
Permittee Company: Stone Sand&Gravel,LLC
Address: P.O. Box 1568
Cortez, CO 81321
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Kathy Stone
Company: Stone Sand&Gravel,LLC
Address: P.O. Box 1568
Cortez,CO 81321
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Inspection Contact: Kathy Stone
Company: Stone Sand&Gravel,LLC
Address: P.O. Box 1568
Cortez,CO 81321
Phone Number: [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.
Z7
Signature of rmittee,kCorporate Officer,Owner, r Documented Desianee Date
M-AF-01