2017-06-26_REPORT - M1998052

• Permit No: M1998052
• IBM Index Class Name: Report
• Doc Date: 6/26/2017
• Doc Name: Annual Fee/Report/Map
• From: Everist Materials
• To: DRMS
• Annual Report Year: 2017
• Email Name: ECS
• 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:
Mahlon Dysart
�Dts 1 V,UAV
Permittee Company:
Everist Materials, LLC
Address:
P.O. Box 1150
Silverthorne, CO 80498
Phone Number:
[phone]
Fax Number:
Email Address:
[e-mail]
Permitting Contact:
Eric Blaylock
��ry• ►(Y1vP�1
Company:
Everist Materials, LLC
Address:
P.O. Box 1150
28755 Hwy 9
Silverthorne, CO 80498
Phone Number:
[phone]
Fax Number:
Email Address:
Inspection Contact:
Eric Blaylock
h�
Company:
Everist Materials, LLC
Address:
P.O. Box 1150
28755 Hwy 9
Silverthorne, CO 80498
_
Phone Number:
[phone]
Fax Number:
"5
Email Address:
ovl m�e ma,f�
1, the undersigned, hereby state that the
being conducted in accord4pce wio(Ne
on provided in this report is true and accurate, and that site operations are
approved mining and reclamation plans.
Signature of
%I AF -01
Date