2017-09-20_REPORT - M1980205 ‎(2)‎

• Permit No: M1980205
• IBM Index Class Name: Report
• Doc Date: 9/20/2017
• Doc Name: Annual Fee/Report/Map
• From: Leister Materials dba Select Materials
• To: DRMS
• Annual Report Year: 2017
• 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: Michael Leister
Permittee Company: Leister Materials Limited DBA
Select Materials
Address: 17269 CR 12
Ft. Lupton, CO 80621
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Permitting Contact: Michael Leister
Company: Leister Materials Limited DBA
Select Materials
Address: 17269 CR 12
Ft. Lupton, CO 80621
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: Michael Leister
Company: Leister Materials Limited DBA
Select Materials
Address: 17269 CR 12
Ft. Lupton, CO 80621
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.
r
Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-01