2017-09-28_REPORT - M1974092

• Permit No: M1974092
• IBM Index Class Name: REPORT
• Doc Date: 9/28/2017
• Doc Name: Annual Fee/Report/Map
• From: Dorn Ready Mix Corp.
• To: DRMS
• Annual Report Year: 2017
• 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: Doug Dowling
Permittee Company: Dorn Ready Mix Corp.
Address: 19671 Rd R 7
P.O. Box 636
Fort Morgan,CO 80701
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: Doug Dowling
Company: Dorn Ready-Mix Corp
Address: 19671 Rd R 7
Fort Morgan,CO 80701
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: Doug Dowling
Company: Dorn Ready-Mix Corp
Address: 19671 Rd R 7
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 conducte 'n accordance w' the Division approved mining and reclamation plans.
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Si natu of Perini tee Coro
p to Officer,Owner,or Documented Designee Date
M-AF-01