2017-09-06_REPORT - M1981075

• Permit No: M1981075
• IBM Index Class Name: REPORT
• Doc Date: 9/6/2017
• Doc Name: Annual Fee/Report/Map
• From: Phillips Stone Company
• 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: Frances A.Phillips
Permittee Company: Phillips Stone Company, Inc.
Address: 7850 Ute Hwy
Longmont,CO 80503
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: Cheri K.Vandergrift
Company: Cherylin K.Vandergrift, LLC
Address: 350 Indiana Street, Suite 150
Golden,CO 80401
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Frances Phillips
Company: Phillips Stone Company, Inc.
Address: 7850 Ute Hwy
Longmont,CO 80503
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.
a.
Signature of Permittee,Corporate 6hicer,Oviffier,or Documented Designee ate
WAF-01