2017-05-25_REPORT - M1986104

• Permit No: M1986104
• IBM Index Class Name: REPORT
• Doc Date: 5/25/2017
• Doc Name: Annual Fee/Report/Map
• From: Oldcstle SW Group
• To: DRMS
• Annual Report Year: 2016
• Email Name: THM
• 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: Jason Burkey
Permittee Company: Oldcastle SW Group, Inc. dba B
&B Excavating
Address: P.O. Box 3609
Grand Junction, CO 81502-
3609
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Jason Burkey
Company: Oldcastle SW Group, Inc. dba B
&B Excavating
Address: P.O. Box 3609
Grand Junction, CO 81502
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: Jason Burkey
Company: Oldcastle SW Group, Inc. dba B
&B Excavating
Address: P.O. Box 3609
Grand Junction, CO 81502
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
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.
1:4�47 ,6 s@/7
Signature of Per ittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-01