2017-07-21_REVISION - M2006017

• Permit No: M2006017
• IBM Index Class Name: REVISION
• Doc Date: 7/21/2017
• Doc Name: Application
• From: Premier Silica LLC
• To: DRMS
• Type & Sequence: SO2
• Email Name: TC1
• Media Type: D
• Archive: No

(if different from above): (Street mine and number or Post Office Box information)
(City) (State) (Postall7.ip Code)
(Province-if applicable) (County,-if not US)
9.Name(s)and mailing address(es)
of person(s)forming the limited
liability company:
(if an individual) Jindra Jeffrey M.
(Last) (First) (Middle) (Suffix)
OR(if a business organization)
16449 Dearing Road
(Street twine and number or Post Office Box information)
Colorado Springs CO 80928
(City) U4g&States (Post 'p"e)
(Province-if applicable) (Country-if not US)
(if an individual) Jindra Maria L.
(Last) (First) (Middle) (Suffix)
OR(if a business organization)
16449 Dearing Road
(Street name and number or Post Office Box information)
Colorado Springs CS O 80928
(City) Urihe States (Postal0p Code)
(Province if applicable) (Country-if not US)
(if an individual)
(Last) (First) (Middle) (Suffix)
OR(if a business organization)
(Street name and number or Post Office Bar information)
(City) ( tat (PostaU7.ip Code)
UnI ei States
(Province-if applicable) (Counts'-if not US)
(If more than three persons are firming the limited habdat com m pa ,nwrk this box ❑atul include an attachment stating the true
nitres and mailing addresser cif all additional persons forming the limited liabilit company)
10.The management of the limited liability company is vested in managers 0
OR is vested in the members
11.There is at least one member of the limited liability company.
ARTORG-LLC Page 2 of 3 Rev.I 1/16/2005