2017-11-16_REPORT - M1987038

• Permit No: M1987038
• IBM Index Class Name: REPORT
• Doc Date: 11/16/2017
• Doc Name: Annual Fee/Report/Map
• From: Oldcastle SW Group, Inc. dba Four Corners Materials
• To: DRMS
• Annual Report Year: 2017
• Email Name: LJW
• Media Type: D
• Archive: No

Page 5of3
Divisionieco ds indicate the folluwingpaitiiiiee iandowe co tact infurutatio`n jvia k fields indicatethat we c e—nit ix�ve
information on record). If this information is blank or not current,please type or print curreut contact infonnatiioit
TennitteeContact: j WiattCalm
Permittee Company_ Oldcastle SW Orotp.Inc.dba Fear
Corners'Materials
Address: P.O. Box 1969
Bayfield, CO 81122-1969
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Peter Kearl
Company: Oldcastle SW Group, Inc. dba Four
Corners Materials
Address: P.O. Box 1969
Bayfield, CO 81122-1969
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: Peter-Ilearl- /I��7 C ✓h->G,an
Company: Oldcastle SW Group, Inc. dba Four
Corners Materials
Address: P.O. Box 1969
Bayfield, CO 81122-1969
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.
te-60t ;vice �A v .n e/in ( ►./l ✓. I 1/12/261d
Signat e of Permittee,Corporate Officer,Owner,or Documented D lsignee Date
M-AF-01