2017-08-29_REPORT - M1986105

• Permit No: M1986105
• IBM Index Class Name: REPORT
• Doc Date: 8/29/2017
• Doc Name: Annual Fee/Report/Map
• From: Dilleys Sand & Gravel
• To: DRMS
• Annual Report Year: 2017
• Email Name: JLE
• 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: Gwen Dilley
Pern►itlee Company: Dilleys Sand&Gravel'
Address: 1914 Edmunds St
P O Box 125
Brush, CO 80723
Phone Number: [phone]
Fax Number:
Email Address: t)nr_drmsminadmin(dstate.co.us
Permitting Contact: Gwen Dilley
Company: Dilleys Sand &Gravel
Address: 1914 Edmunds St
P 0 Box 125
Brush,CO 80723 •
Phone Number: ------------- [phone]
Fax Number:
Ismail Address: [e-mail]
Inspection Contact: Gwen Dilley
Company: Dilleys Sand &Gravel
Address: 1914 Edmunds St
I'O Box 125
Brush. CO 80723
Phone Number: [phone]
Fax Number:
Email Address: Dnr_drinsminadmituir!state.co.us
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 11,ith the Division approved mining and reclamation plans.
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Signature of Permittee,Corporate 0 l'cer,Owner,or Documented Desitnee Date
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