2017-05-15_REPORT - M2010007

• Permit No: M2010007
• IBM Index Class Name: REPORT
• Doc Date: 5/15/2017
• Doc Name: Annual Fee/Report/Map
• From: Northwest Aggregates
• To: DRMS
• Annual Report Year: 2017
• Email Name: ACY
• 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: Roger Simones
Permittee Company: Northwest Aggregates, Inc.
Address: 2930 E. US Hwy 40 Suite 4
Craig, CO 81625
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Permitting Contact: Steve Baker
Company: Steve Baker
Address: P.O. Box 1665
Craig, CO 81626
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: Roger Simones
Company: Northwest Aggregates,Inc.
Address: 2930 E. US Hwy 40,
Suite 4
Craig, Co 81625
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 ' h the Division approved mining and reclamation plans.
—4,ell ra�'e - - /7
Sign a of P rmitte ,Corporate Officer,Owner,or Documented Designee Date
M-AF-O