2017-06-01_REPORT - M2016015

• Permit No: M2016015
• IBM Index Class Name: REPORT
• Doc Date: 6/1/2017
• Doc Name: Annual Fee/Report/Map
• From: Lucky VI Quarry
• To: DRMS
• Annual Report Year: 2017
• Email Name: TC1
• Media Type: D
• Archive: No

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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: Ed Lyons
Permitt e Company: Lucky VI Quarry
Address: 228 County Road 251
P.O. Box 875
Westcliffe, CO 81252
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Ed Lyons
Company: Lucky VI Quarry
Address: 228 County Road 251
Westcliffe, CO 81252
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Inspection Contact: Ed Lyons
Company: Lucky VI Quarry
Address: 228 County Road 251
Westcliffe, CO 81252
Phone Number: [phone]
Fax Number: [phone]
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
being conducted in accordance with the Division approved mining and reclamation plans.
5-3o - l7
Signature of Per ' tee Cor orate Officer,Owner,or Documented Desienee Date
M-AF-01