2017-04-17_M1976032_Annual Fee Notice ARCHIVE

• Permit No: M1976032A
• IBM Index Class Name: Report
• Doc Date: 4/17/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Oldcastle SW Group, Inc. dba Telluride Gravel
• Annual Report Year: 2017
• Media Type: D
• Archive: Yes

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:

Jason Burkey
Permittee Company:

Oldcastle SW Group, Inc. dba
Telluride Gravel

Address:

P.O. Box 3609
Grand Junction, CO 81502

Phone Number:

[phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact:

Greg Homan
Company:

Oldcastle SW Group, Inc. dba
Telluride Gravel

Address:

Drawer U
Cortez, CO 81321

Phone Number:

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

Greg Homan
Company:

Oldcastle SW Group, Inc. dba
Telluride Gravel

Address:

270 Highway 625
Telluride, CO 81321

Phone Number:

[phone]
Fax Number: [phone]
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.

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