2018-01-08_REPORT - M1987092

• Permit No: M1987092
• IBM Index Class Name: Report
• Doc Date: 1/8/2018
• Doc Name Note: Request for Annual Report
• Doc Name: Request for Annual Report
• From: DRMS
• To: Blue Mountain Stone
• Email Name: AME
• Email Name: BJC
• 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:
Abe Vasquez
Permittee Company:
Blue Mountain Stone
Address:
4168 Ute Hwy
Longmont, CO 80503
Phone Number:
[phone]
Fax Number:
[phone]
Email Address:
Permitting Contact:
Company:
Blue Mountain Stone
Address;
Phone Number:
[phone]
Fax Number:
Email Address:
Inspection Contact:
Raul Vasquez
Company:
Blue Mountain Stone
Address:
4168 Ute Hwy
Longmont, CO 80503
Phone Number:
[phone]
Fax Number:
Email Address:
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 Desisnee
M6 AF-Ui
Date