2017-12-18_REPORT - M2010062

• Permit No: M2010062
• IBM Index Class Name: REPORT
• Doc Date: 12/18/2017
• Doc Name: Annual Fee/Report/Map
• From: White Sand & Gravel
• To: DRMS
• Annual Report Year: 2017
• Email Name: MAC
• 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: Tim White
Permittee Company: White Sand&Gravel,LLC
Address: 7 N St Road
Box 806
Elkhart,KS 67950
Phone Number: [phone]
Fax Number: l
Email Address: [e-mail]
Permitting Contact: Tim White b
Company: White Sand&Gravel,LLC
Address: 7 N St Road
Box 806
Elkhart,KS 67950
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: Tim White
Company: White Sand&Gravel,LLC
Address: 7 N St Road
Box 806
Elkhart,KS 67950
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.
Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-01