2017-02-21_M1977195_Annual Fee Notice ARCHIVE

• Permit No: M1977195A
• IBM Index Class Name: Report
• Doc Date: 2/21/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Hard Rock Paving and Redi-Mix, Inc.
• Annual Report Year: 2017
• Media Type: D
• Archive: Yes

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:

Jodi Ricker
Permittee Company:

Hard Rock Paving and Redi-
Mix, Inc.

Address:

P.O. Box 165
Canon City, CO 81215

Phone Number:

[phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact:

Jodi Ricker
Company:

A&S Construction
Address:

P.O. Box 1720
Canon City, CO 81215

Phone Number:

[phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact:

John Ary
Company:

Hard Rock Paving & Redi Mix,
Inc.

Address:

P.O. Box 841
Canon City, CO 81215

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.

Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date
M-AF-01