2015-10-27_REPORT - M1980224

• Permit No: M1980224
• IBM Index Class Name: REPORT
• Doc Date: 10/27/2015
• Doc Name: Annual fee, report, map
• From: Fremont Paving & Ready Mix Inc.
• To: DRMS
• Email Name: TC1
• 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:
John P. Ary
Permittee Company:
Fremont Paving & Redi-Mix,
Inc.
Address:
P.O. Box 841
Canon City, CO 81215
Phone Number:
[phone]
Fax Number:
[phone]
Email Address:
I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are
being conducte cordance wit e ivision approved mining and reclamation plans.
� P3 -j -'5 -
of Permittee Cor or O, Owner, or Documented Designee Date
M -AF -01