2017-05-09_REPORT - M1987013

• Permit No: M1987013
• IBM Index Class Name: REPORT
• Doc Date: 5/9/2017
• Doc Name: Annual Fee/Report/Map
• From: Southway Construction
• To: DRMS
• Annual Report Year: 2016
• Email Name: THM
• 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: Rock 1. Southway
Permittee Company: Southway Construction
Corn an , Inc.
Address: 117 White Pine Dr
Alamosa, CO 81101
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Permitting Contact: Ralph Martinez
Company: Southway Construction
Corn an , Inc.
Address: 117 White Pine Dr
Alamosa, CO 81101
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Joe Gagliano
Ra
Company: L J Development, Inc.
SCi.• S G►G iE�vi. U
Address: 256 N.Merrill Drlve
Pueblo West,CO 81007
I WIC; Aa„r s c �
Phone Number: [phone]
?- y -4-1 O 3
Fax Number: [phone]
Ml-
Email Address:
I,the undersigned,hereby state that the information provided in this report is true and accurate, and that site operations are
being conducted in accordance with the Division approved mining and reclamation plans.
OAP VA,
SignatuA of Permittee Co orate Officer,Owner,or Documented Designee Date
M-AF-01