2017-03-02_REPORT - M2009010

• Permit No: M2009010
• IBM Index Class Name: REPORT
• Doc Date: 3/2/2017
• Doc Name: Annual Fee/Report/Map
• From: McCormick Excavation & Paving, LLC
• To: DRMS
• Annual Report Year: 2017
• Email Name: ERR
• 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: James McCormick
Permittee Company: McCormick Excavation&
Paving,LLC
Address: 30887 Hwy 24
Stratton,CO 80836
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Permitting Contact: James McCormick
Company: McCormick Excavation&
Paving,LLC
Address: 30887 Hwy 24
Stratton,CO 80836
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: James McCormick
Company: McCormick Excavation&
Paving,LLC
Address: 30887 Hwy 24
Stratton, CO 80836
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
1,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.
a .2..2�-
Signature Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-OI