2017-04-14_REPORT - M1974015

• Permit No: M1974015
• IBM Index Class Name: REPORT
• Doc Date: 4/14/2017
• Doc Name: Annual Fee/Report/Map
• From: Martin Marietta Materials
• To: DRMS
• Annual Report Year: 2017
• Email Name: AME
• 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: Julie Mikulas
Permittee Company: Martin Marietta Materials, Inc.
Address: 1800 N. Taft Hill Road
Fort Collins,CO 80521
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Julie Mikulas
Company: Martin Marietta Materials,Inc.
Address: 1800 N. Taft Hill Road
Fort Collins,CO 80521
Phone Number: [phone]
Fax Number: [phone]
Email Address: J lt- i.e•M'k l�(1 - ® 1yt OUW*te�-Um
Inspection Contact: Julie Mikulas ,S
Company: Martin Marietta Materials,Inc.
Address: 1800 N. Taft Hill Road
Fort Collins,CO 80521
Phone Number: [phone]
Fax Number: [phone]
Email Address: '
�u,lt� •'V1al Ljas.Q NiLU''4'l rl Mart e'f-It...c
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.
9 dt�C' . I A - I A _;-a3-/1
Sig ture of Permittee,Coraorate Officer,Owner,or 66cumented Desienee Date
M-AF-01