2017-01-17_REPORT - M1998034

• Permit No: M1998034
• IBM Index Class Name: Report
• Doc Date: 1/17/2017
• Doc Name: Annual Fee/Report Notice
• From: DRMS
• To: Mountain Park Concrete
• 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:

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
Company:

Mountain Park Concrete, Inc.
Address:

919 CR 612
P.O. Box 856
Granby, CO 80446

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