2017-12-06_REPORT - M1984041 ‎(2)‎

• Permit No: M1984041
• IBM Index Class Name: REPORT
• Doc Date: 12/6/2017
• Doc Name: Annual Fee/Report/Map
• From: American Gypsum
• To: DRMS
• Annual Report Year: 2017
• Email Name: THM
• 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: Jared D. Rhea
Permittee Company: American Gypsum Company
LLC
Address: 740 Hwy 6
PO Box 980
Gypsum, CO 81637
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Jared D.Rhea
Company: American Gypsum Company
LLC
Address: 740 Hwy 6
PO Box 980
Gypsum, CO 81637
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Inspection Contact: Jared D.Rhea
Company: American Gypsum Company
LLC
Address: 740 Hwy 6
PO Box 980
Gypsum, CO 81637
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
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.
Signature o P rmi t Cor orate Officer,Owner,or Documented Desienee Dafe
M-AF-01