2017-04-12_REPORT - M2000049

• Permit No: M2000049
• IBM Index Class Name: REPORT
• Doc Date: 4/12/2017
• Doc Name: Annual Fee/Report/Map
• From: Louisiana Land and Gravel Company, LLC
• To: DRMS
• Annual Report Year: 2017
• Email Name: DMC
• 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: Michael A. DeJohn
Permittee Company: Louisiana Land and Gravel
Company, LLC
Address: P.O. Box 8419
Clinton,LA 70722
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact:
Company:
Address:
Phone Number:
Fax Number:
Email Address:
Inspection Contact: Ward Priestly
Company: Hank Williams, Inc.
Address: P.O. Box 704
Norwood,CO 81423
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.
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Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-01