2017-03-21_REPORT - M1977197

• Permit No: M1977197
• IBM Index Class Name: REPORT
• Doc Date: 3/21/2017
• Doc Name: Annual Fee/Report/Map
• From: Hard Rock Paving and Redi-Mix, Inc.
• 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: Steve Chisolm
Permittee Company: Hard Rock Paving and Redi-
Mix, Inc.
Address: PO Box 165
Canon City, CO 81215
Phone Number: [phone]
Fax Number: [phone]
curp.
Email Address: [e-mail]
Permitting Contact: Lloyd V.Barnhart
Company: Barnhart Agency, Inc.
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Address: 212 W. 13th Street
Pueblo,CO 81003 �'u Kok l la S
UWbV\ 'b $la+-
Phone Number: [phone]
Fax Number: [phone]
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Email Address:
Inspection Contact: Gary Reed
Company: Hard Rock Paving&Redi Mix,
Inc.
Address: 839 Mackenzie Ave.
Canon City, CO 81212
Phone Number: [phone]
Fax Number: [phone]
Email Address:
1,the un a 'gned,hereby state that the information provided in this report is true and accurate, and that site operations are
being co du ted o nce with the Division approved mining and reclamation plans.
� 1"1
Signature Y
Per e C orat OfficeOwner,or Documented Designee Date
M-AF-01