2017-09-06_REPORT - M1981112

• Permit No: M1981112
• IBM Index Class Name: REPORT
• Doc Date: 9/6/2017
• Doc Name Note: Annual Map
• Doc Name: Annual Map
• From: Builders Aggregate
• To: DRMS
• Annual Report Year: 2016
• 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: James S.Miner
Permittee Company: Builder's Aggregate, Inc.
Address: 510 Dahlia St.
Fort Morgan, CO 80701
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: James S. Miner
Company: Builder's Aggregate, Inc.
Address: 510 Dahlia St.
Fort Morgan, CO 80701
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: James S.Miner
Company: Builder's Aggregate, Inc.
Address: 510 Dahlia St.
Fort Morgan, CO 80701
Phone Number: [phone]
Fax Number:
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.
d� ,� J) �&� q -17
i ature of Permittee,Corporate Officer,Owner,or Documented Designee Date
AF-01