2017-07-06_REPORT - M1992051

• Permit No: M1992051
• IBM Index Class Name: REPORT
• Doc Date: 7/6/2017
• Doc Name: Annual Fee/Report/Map
• From: Langston Concrete
• To: DRMS
• Annual Report Year: 2016
• Email Name: TC1
• 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: Mike Langston
Permittee Company: Langston Concrete, Inc.
Address: 902 South Union Street
P.O. Box 279
Florence, CO 81226
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Permitting Contact: Mike Langston
Company: Langston Concrete, Inc.
Address: 902 South Union Street
P.O. Box 279
Florence,CO 81226
Phone Number: [phone]
Fax Number:
Email Address: Mlangston@,newlci.com
Inspection Contact: Mike Langston
Company: Langston Concrete, Inc.
Address: 902 South Union Street
P.O. Box 279
Florence,CO 81226
Phone Number: [phone]
Fax Number:
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 reclamationplans.
Sianatu rof Per ee Cor orate Of icer,Owner,or Documente Designee ate