2017-09-14_REPORT - M2004030

• Permit No: M2004030
• IBM Index Class Name: REPORT
• Doc Date: 9/14/2017
• Doc Name: Annual Fee/Report/Map
• From: T Bone Stone, Inc.
• 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: Bill Tenore
Permittee Company: T Bone Stone, Inc.
Address: 2337 Emery St
Longmont, CO 80501
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Bill Tenore
Company: T Bone Stone, Inc.
Address: 2337 Emery St
Longmont, CO 80501
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Bill Tenore
Company: T Bone Stone, Inc.
Address: 2337 Emery St
Longmont, CO 80501
Phone Number: [phone]
Fax Number: [phone]
Email Address: L
I,the undersigned,hereby state that the information provided in this report is true and accurate, and that site operations are
bein ucte accor i t e ision approved mining and reclamation plans.
Sigma o ermittee Cor rate Officer,Owner,or Documented Designee Date
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M-AF-01