2017-07-28_REPORT - M1979131

• Permit No: M1979131
• IBM Index Class Name: REPORT
• Doc Date: 7/28/2017
• Doc Name: Annual Fee/Report/Map
• From: Korinek Sand & Gravel
• To: DRMS
• Annual Report Year: 2016
• Email Name: AME
• 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: Gerald Korinek
Permittee Company: Korinek Sand& Gravel
Address: 640 Lane 15
Manzanola, CO 81058
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Permitting Contact: Gerald Korinek
Company: Korinek Sand&Gravel
Address: 640 Lane 15
Manzanula, CO 81058
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Gerald Korinek
Company: Korinek Sand&Gravel
Address: 640 Lane 15
Manzanula, CO 81058
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.
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Si ature of Permittee,Corporate Officer,Owner,or Documented Designee to
M-AF-01