2017-03-07_REPORT - M1981207

• Permit No: M1981207
• IBM Index Class Name: REPORT
• Doc Date: 3/7/2017
• Doc Name: Annual Fee/Report/Map
• From: Western Slope Materials, LLC
• To: DRMS
• Annual Report Year: 2017
• Email Name: ACY
• 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: Sean Mello
Permittee Company: Western Slope Materials,LLC
Address: P O Box 1319
Carbondale, CO 81623
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Permitting Contact: Sean Mello
Company: Western Slope Materials,LLC
Address: P O Box 1319
Carbondale, CO 81623
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: Sean Mello
Company: Western Slope Aggregates,Inc.
Address: P O Box 1319
Carbondale,CO 81623
Phone Number: [phone]
Fax Number:
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.
A 6l 4JC-A,. *AAA v Z R Cv 1
Signature of Permitte ,Corporate Officer,Owner,or Documented Designee Date
M-AF-01