2017-05-03_REPORT - M1986048

• Permit No: M1986048
• IBM Index Class Name: REPORT
• Doc Date: 5/3/2017
• Doc Name: Annual Fee/Report/Map
• From: R & J Yetter S & G
• 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: Jewelie Yetter
Permittee Company: R&J Yetter Sand&Gravel
LLC
Address: 16757 CR 16
Atwood, CO 80722
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Permitting Contact: Jewelie Yetter
Company: R&J Yetter Sand&Gravel
LLC
Address: 16757 CR 16
Atwood,CO 80722
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: Jewelie Yetter
Company: R&J Yetter Sand&Gravel
LLC
Address: 16757 CR 16
Atwood,CO 80722
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
1,the undersigned,hereby state that the information provided in this report is true and accurate, and that site operations are
bein conducted in accordance with the Division approved mining and reclamation plans.
Sigfifiture of Permitte Cor orate Officer,Owner,or Documented Designee Date
M-AFT