2017-07-26_REPORT - M2004031

• Permit No: M2004031
• IBM Index Class Name: Report
• Doc Date: 7/26/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Aggregate Industries - WCR, Inc.
• Annual Report Year: 2017
• 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:

Connie Davis
Permittee Company:

Aggregate Industries - WCR,
Inc.

Address:

1687 Cole Blvd., Ste. 300
Golden, CO 80401

Phone Number:

[phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact:

Pam Hora
Company:

Tetra Tech RMC
Address:

1900 S. Sunset, Ste 1-F
Longmont, CO 80501

Phone Number:

[phone]
Fax Number: [phone]
Email Address:
Inspection Contact:

Mike Refer
Company:

Aggregate Industries - WCR,
Inc.

Address:

1687 Cole Blvd., Ste. 300
Golden, CO 80401

Phone Number:

[phone]
Fax Number: [phone]
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.

Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date
M-AF-01