2017-02-28_REPORT - M1985008

• Permit No: M1985008
• IBM Index Class Name: REPORT
• Doc Date: 2/28/2017
• Doc Name: Annual Fee/Report/Map
• From: Hard Rock Paving & Redi Mix
• To: DRMS
• Annual Report Year: 2017
• Email Name: ECS
• 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: John P.Ary
Permittee Company: Hard Rock Paving and Redi-
Mix,Inc.
Address: 839 Mackenzie Ave
P.O.Box 165
Canon City,CO 81215
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Permitting Contact: John P.Avry
Company: Hard Rock Paving and Redi- v
Mix,Inc.
Address: 839 Mackenzie Ave
Canon City,CO 81212
Phone Number: [phone]
1 So� -091C.p
Fax Number: dd-�r'� v
Email Address:
Inspection Contact: John P.-Awq-
Company: Hard Rock Paving and Redi-
Mix,Inc.
Address: 839 Mackenzie Ave
Canon City,CO 81212
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
bei co duc d in accordance with the Division approved mining and reclamation plans.
d� 1
Sign t e of a orate OMEW Owner,or Documented Designee Date
M-AF-01