2017-06-27_REPORT - M1985001

• Permit No: M1985001
• IBM Index Class Name: REPORT
• Doc Date: 6/27/2017
• Doc Name: Annual Fee/Report/Map
• From: Glacier Gravel Products
• To: DRMS
• Annual Report Year: 2016
• Email Name: LJW
• 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: Tim Helmericks
Perms Cry Glacier Gravel Prodoct.s
Address: 995 Hwy 3
Durango,CO 81301
Phone Number. [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Jun Helmericks Alternate: Nathan A. Barton
Company: Glacier Gravel Products WASTELINE, Inc.
Address: 995 Hwy 3
Durango,CO 81301 PO Box 88, Cortez, CO 01321
Phone Number: [phone] [phone]
Fax Number.
Email Address: Duran oGravel frontier.net
9 @ [e-mail]
lwgme tim CARtact: Jim Helmericks
Company: Glacier Gravel Products
Address: 995 Hwy 3
Durango,CO 81301
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.
.� I 0'� -01-17
Signature of Permittee.Corporate Officer.Owner,or Documented Designee Date
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