2015-08-07_REPORT - M2001052

• Permit No: M2001052
• IBM Index Class Name: REPORT
• Doc Date: 8/7/2015
• Doc Name: Annual Fee, Report and Map
• From: McCormick Excavation & Paving, LLC
• To: DRMS
• Email Name: ERR
• Media Type: D
• Archive: No

Page 5 of 5
Division records indicate the following permittee contact information. If this information is not current, please type or
print current contact information:
Permittee Contact:
Jim McCormick
Permittee Company:
McCormick Excavation &
Paving, LLC
Address:
30887 US Highway 24
Stratton, CO 80836
Phone Number:
[phone]
Fax Number:
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.
of Permittee, Corporate Officer, Owner, or Documented Designee
M -AF -01
z — ?o
Date