2017-02-08_REPORT - M1979155 ‎(2)‎

• Permit No: M1979155
• IBM Index Class Name: Report
• Doc Date: 2/8/2017
• Doc Name: Annual Fee/Report/Map
• From: CDOT
• To: DRMS
• Email Name: THM
• 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:
Rex Goodrich
C� ✓1 (�2 .1 r
Company:
Colorado Department of
Transportation
Address:
222 S 6th St Rm 317
Grand Jy�a 'onet� , CO 81501
jc
Phone Number:
(970) 2
Fax Number:
Email Address:
Inspection Contact:
Rex Go
llviclr'
Company:
Colorado Department of
Transportation
Address:
222 S 6ty5jRm 317
G�ud unction, CO 81501
Phone Number:
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.
Signature d Permittee, Corporate Officer, Owner, or Documented Desilinee
M -AF -04
Z -20 -11 -
Date
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