2017-04-26_REPORT - M1985211

• Permit No: M1985211
• IBM Index Class Name: REPORT
• Doc Date: 4/26/2017
• Doc Name: Annual Fee/Report/Map
• From: ARKINS PARK STONE CORPORATION
• To: DRMS
• Annual Report Year: 2017
• Email Name: JLE
• 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: Arlis M. Sprague
Permittee Company: ARKINS PARK STONE
CORPORATION
Address: 5975 NCR 27
Loveland, CO 80538
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: Judy Sprague
Company: Arkins Park Stone Corp.
Address: 5975 NCR 27
Loveland,CO 80538
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: Judy Sprague
Company: Arkins Park Stone Corp.
Address: 5975 NCR 27
Loveland, CO 80538
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.
a4�'U- � 31Z, -7
Sign t re of Pei n itteE-d-6riDorate Micer,Owner,or Documented Designee Date
M-AF- 1