2017-08-29_REPORT - M2012023

• Permit No: M2012023
• IBM Index Class Name: REPORT
• Doc Date: 8/29/2017
• Doc Name: Annual Fee/Report/Map
• From: Tamrock Gravel LLC
• To: DRMS
• Annual Report Year: 2017
• Email Name: MAC
• 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: Brent A.Tamburelli
Permittee Company: Tamrock Gravel LLC
Address: 137 East Plum St.
Trinidad, CO 81082
Phone Number: [phone]
Fax Number: 7/17
s17 Y4-fie 74/2-
Email
qLEmail Address: 9;Iztx_1(...)
Permitting Contact: ✓
Company:
Address:
Phone Number:
Fax Number:
Email Address:
Inspection Contact: Brent A.Tamburelli
Company: Tamrock Gravel
Address: 137 East Plum St.
Trinidad, CO 81082
Phone Number: [phone]
Fax Number: 7/ k q( -7 qZ
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.
/// C9!„..?//—/
Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-OI