2017-10-24_REPORT - M1978271

• Permit No: M1978271
• IBM Index Class Name: REPORT
• Doc Date: 10/24/2017
• Doc Name: Annual Fee/Report/Map
• From: Asphalt Gravel Products
• To: DRMS
• Annual Report Year: 2017
• Email Name: DMC
• 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: Rock 1. Southway
Permittee Company: Asphalt Gravel Products, Inc.
Address: 117 White Pine Dr
Alamosa, CO 81101
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: John Ungefug �
Company: Asphalt Gravel Products, Inc.
Address: 117 White Pine Dr
Alamosa, CO 81101
Phone Number: [phone]
Fax Number: 71��S 9'� s�•a� �
Email Address: �
Sa .e Sep 77,wa Cd.
Inspection Contact: John Ungefug
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Company: Asphalt Gravel Products, Inc.
Address: 117 White Pine Dr
Alamosa, CO 81101
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.
�0- 1`7' �-O/~l
Signatu of Permittee Co rate Officer,Owner,or Documented Designee Date
M-AY-01