2017-06-12_REPORT - M1994121

• Permit No: M1994121
• IBM Index Class Name: REPORT
• Doc Date: 6/12/2017
• Doc Name: Annual Fee/Report/Map
• From: O & A Stone LLC
• To: DRMS
• Annual Report Year: 2017
• Email Name: AME
• 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: Arturo Vasquez
Permittee Company: O&A Stone LLC
Address: P.O. Box 2526
Longmont,CO 80502
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact:
Company: O&A Stone LLC
Address: P.O. Box 2526
Longmont,CO 8050 f�
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact:
Company: O&A Stone LLC V
Address: P.O. Box 2526
Longmont,CO 8050Y
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.
C(C> 9 A-1
Signs ure of Perml raorate O ficer,Owner,or Documented Designee Date
M-AI-01