2017-02-08_REPORT - M1986037

• Permit No: M1986037
• IBM Index Class Name: REPORT
• Doc Date: 2/8/2017
• Doc Name Note: Annual Report and Map
• Doc Name: Annual Report and Map
• From: CDOT
• To: DRMS
• Annual Report Year: 2017
• Email Name: DMC
• 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: Kane Schneider
Permittee Company: Colorado Department of
Transportation
Address: 606 S. 9th St.
Grand Junction, CO 81501
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Jason
Company: Colorado Department of
Transportation
Address: 222 S 6th St Rm 3
Grand on, CO 81501 Cr,� CJ �< < S V/
Phone Number: 970 683-
( � c � � �` (�:3 CR� ✓
Fax Number: [phone]
Email Address:
Inspection Contact: Jason
Company: Colorado Department of
Transportation
Address: 222 S 6th 317 t ��
Gra unction, CO 81501 (F' J
619tlewd —fc- OV
Phone Number: (970)6 1
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 conducted in accordance with the Division approved mining and reclamation plans.
Signaturel6f,Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-04