2016-12-29_REPORT - M1982155

• Permit No: M1982155
• IBM Index Class Name: REPORT
• Doc Date: 12/29/2016
• Doc Name: Annual Fee/Report/Map
• From: Schmidt Construction Co.
• To: DRMS
• Annual Report Year: 2016
• Email Name: TC1
• 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: Scott Davis
Permittee Company: Schmidt Construction Company
Address: 2635 Delta Dr.
Colorado Springs , CO 80910
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Bill Schenderlein Scott Davis
Company: Blue Earth Schmidt Construction Company
Address: P.O. Box 973
Fort Collins,CO 80522 2635 Delta Drive
Colorado Springs, CO 80910
Phone Number: [phone] [phone]
Fax Number: [phone]
Email Address: SDAVIS@ schmidtconstr.com
Inspection.Contact: Dan Chavez
Company: Schmidt Construction Company
Address: 900 S.Charter Oak Ranch Road
Fountain,CO 80817
Phone Number: [phone]
Fax Number:
Email Address:
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.
WY/;' .0- 06V
�4; V. IQ Y/
Signature of Pen tte=e Corporate OftiEcer,Owner,or Documented Designee Date