2017-09-18_REPORT - M1999042

• Permit No: M1999042
• IBM Index Class Name: REPORT
• Doc Date: 9/18/2017
• Doc Name: Annual Fee/Report/Map
• From: Avalanche Creek Marble & Alabaster
• To: DRMS
• Annual Report Year: 2016
• Email Name: SJM
• 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: Robert Congdon
Permittee Company: Avalanche Creek Marble&
Alabaster LLC
Address: PO Box 932
Carbondale, CO 81623
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Permitting Contact:
Company:
Address:
Phone Number:
Fax Number:
Email Address:
Inspection Contact: Robert Congdon
Company: Elbram Stone LLC
Address: 0367 Avalanche Creek Road
Carbondale, CO 81623
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
1, 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 Osn� cz-13—
Signature of Permittee,Corporat Officer,Owner,or Documented Designee Date
M-AF-01