2017-03-21_REPORT - M1977196

• Permit No: M1977196
• 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: Jodi Ricker
ain't,PW PON
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] OYNAeDrp rv\
Permitting Contact: Angela Bellantoni
Company: Hard Rock Paving&Redi Mix,
Inc.
Address: 839 Mackenzie Ave.
Canon City,CO 81212
Phone Number: [phone]
Fax Number: [phone]
Email Address: I ,
Inspection Contact: Gary Reed
• �b.lr
Company: Hard Rock Paving&Redi Mix,
Inc.
Address: 839 Mackenzie Ave.
Canon City, CO 81212
Phone Number: [phone]
Fax Number: [phone]
Email Address: ,
r�
I,the undersigned,here b state that the information provided in this report is true and accurate, and that site operations are
being co ucted in acco nce with th Division approved mining and reclamation plans.
Signature ojt Permo!fjLor te Officer,Owner,or Documented Designee Date
M-AF-01