2017-04-21_REPORT - M1977195

• Permit No: M1977195
• IBM Index Class Name: REPORT
• Doc Date: 4/21/2017
• Doc Name: Annual Fee/Report/Map
• From: Hard Rock Paving and Redi-Mix, Inc.
• To: DRMS
• 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
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] ' Od y LY-C COPY%
Permitting Contact: Jodi Ricker
Company: A&S Construction
Address: P.O. Box 1720
Canon City, CO 81215
Phone Number: [phone]
Fax Number:
Email Address: [e-mail] `
Inspection Contact: John Ary
Company: Hard Rock Paving&Redi Mix,
Inc.
Address: P.O. Box 841
Canon City, CO 81215
Phone Number: [phone]
Fax Number:
Email Address:
I,the and igned,here state that the information provided in this report is true and accurate, and that site operations are
being co du to i acco nce with the Division approved mining and reclamation plans.
1
Signatur f Permittee, orporate Officer,Owner,or Documented Designee Date
M-AF-01