2017-02-21_REPORT - M1980228

• Permit No: M1980228
• IBM Index Class Name: Report
• Doc Date: 2/21/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Oldcastle SW Group, Inc. dba Four Corners Materials
• Annual Report Year: 2017
• 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:

Matt R. Carnahan
Permittee Company:

Oldcastle SW Group, Inc. dba Four
Corners Materials

Address:

P.O. Box 1969
Bayfield, CO 81122-1969

Phone Number:

[phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact:

Monte Potter
Company:

Oldcastle SW Group, Inc. dba Four
Corners Materials

Address:

P.O. Box 2707
Durango, CO 81203

Phone Number:

[phone]
Fax Number:
Email Address:
Inspection Contact:

Monte Potter
Company:

Oldcastle SW Group, Inc. dba Four
Corners Materials

Address:

P.O. Box 2707
Durango, CO 81203

Phone Number:

[phone]
Fax Number:
Email Address:

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.

Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date
M-AF-01