2017-03-09_REPORT - M1998034

• Permit No: M1998034
• IBM Index Class Name: REPORT
• Doc Date: 3/9/2017
• Doc Name: Annual Fee/Report/Map
• From: Mountain Park Concrete, 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: Suzanne Docheff
Permittee Company: Mountain Park Concrete,Inc.
Address: P.O. Box 856
Granby, CO 80446
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Gary Tuttle
Company: Tuttle Applegate Inc
Address: 11990 Grant St. Ste 304
Denver, CO 80233-1136
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: M.Joe Docheff,III t
P �7� r� ' eody
Company: Mountain Park Concrete,Inc.
Address: 919CR612Utf ��.ay� �,jv w�g7� �1►^C ��
P.O. Box 856 ( � r�Ux
Granby, CO 80446 YJ
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 cond cted in accordance with the Division approved mining and reclamation plans.
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Signature of ermittee Corporate Offic ner,or Documented Designee Date
M-AF-01