2017-08-14_REPORT - M1997039

• Permit No: M1997039
• IBM Index Class Name: Report
• Doc Date: 8/14/2017
• Doc Name: Annual Fee/Report/Map
• From: Wyatt Redi-Mix Company
• To: DRMS
• Annual Report Year: 2017
• Email Name: PSH
• 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: Richard F. Wyatt
Permittee Company: Wyatt Redi-Mix Company
Address: 690 Harrison Street
P.O.Box 1052
Walden,CO 80480
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: Richard F. Wyatt
Company: Wyatt Redi-Mix Company
Address: 690 Harrison Street
Walden,CO 80480
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Richard F.Wyatt
Company: Wyatt Redi-Mix Company
Address: 690 Harrison Street
Walden,CO 80480
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 cond in accordance with the Division approved mining and reclamation plans.
ff7 /742_
Signature of Permittee,Co rate Officer,Owner,or Documented Designee Date
M-AF-01