2017-09-13_REPORT - M1976018

• Permit No: M1976018
• IBM Index Class Name: Report
• Doc Date: 9/13/2017
• Doc Name: Annual Fee/Report/Map
• From: North Weld Gravel
• To: DRMS
• Annual Report Year: 2016
• Email Name: ECS
• 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: LeRoy A.Bellmore
Permittee Company: North Weld Gravel
Address: 13480 Weld County Rd 100
Nunn,CO 80648-9700
Phone Number: [phone]
Fax Number:
Email Address:
Permitting Contact: LeRoy Bellmore
Company: North Weld Gravel
Address: 13480 Weld County Road 100
Nunn, CO 80648-9700
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: LeRoy Bellmore
Company: North Weld Gravel
Address: 13480 Weld County Road 100
Nunn,CO 80648-9700
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.
Signature of Pe ittee Corporate Officer,Owner,or Documented Designee D e
M-AF-01