2017-04-21_REPORT - M1995008

• Permit No: M1995008
• IBM Index Class Name: REPORT
• Doc Date: 4/21/2017
• Doc Name: Annual Fee/Report/Map
• From: Fremont Paving & Redi-Mix, Inc.
• To: DRMS
• 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 Chisholm
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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]
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Permitting Contact: Jodi Schreiber
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]
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Inspection Contact: Jodi Schreiber
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] \
1,the undersigned,hereby state that the information provided in this report is true and accurate, and t at site operations are
being conducted in ccordance with the Division approved mining and reclamation plans.
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Sig[a re o Permittee or orate Officer,Owner,or Documented Designee Date
M-AF-01