2017-03-21_REPORT - M2000151

• Permit No: M2000151
• IBM Index Class Name: REPORT
• Doc Date: 3/21/2017
• Doc Name: Annual Fee/Report/Map
• From: Fremont Paving & Redi-Mix, Inc.
• To: DRMS
• Annual Report Year: 2017
• Email Name: TC1
• 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: Fremont Paving&Redi-Mix,
Inc.
Address: P.O. Box 841
Canon City, CO 81215
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Angela Bellantoni
�O�a►
Company: Fremont Paving&Redi-Mix Inc
Address: P.O. Box 1720
Canon City,CO 81215-1720
Phone Number: [phone]
Fax Number: [phone]
Email Address:
dd� r i ck�r� .C�x•�
Inspection Contact: Angela Bellantoni
Company: Fremont Paving&Redi-Mix Inc
Address: P.O. Box 1720
Canon City,CO 81215-1720
Phone Number: [phone]
Fax Number: [phone]
Email Address:
I,the undersjj ' d,hereb st that the information provided in this report is true and accurate, and that site operations are
being cond ct' ed In o e wi the Divisio ved mining and reclamation plans.
Signature of EV "r rate Officer,Owne r Doci ted Designee Date
M-AF-01