2017-03-17_REPORT - M2011013

• Permit No: M2011013
• IBM Index Class Name: Report
• Doc Date: 3/17/2017
• Doc Name: Annual Fee/Report Notice
• From: DRMS
• To: Telluride Stone
• Annual Report Year: 2017
• Permit Index Doc Type: Annual Fee/Report
• 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:

John Gallegos
Permittee Company:

Telluride Stone Company Inc.
Address:

P.O. Box 3552
Telluride, CO 81435

Phone Number:

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

Bill Balaz
Company:

Tetra Tech Inc.
Address:

825 North Crest Drive Suite 2
Grand Junction, CO 81506

Phone Number:

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

Karen Moore
Company:

Telluride Stone Company Inc.
Address:

P.O. Box 3552
Telluride, CO 81435

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.

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