2017-05-31_REPORT - M2000041

• Permit No: M2000041
• IBM Index Class Name: REPORT
• Doc Date: 5/31/2017
• Doc Name: Annual Fee/Report/Map
• From: Fremont Paving & Redi-Mix, Inc.
• To: DRMS
• Annual Report Year: 2017
• Email Name: ERR
• 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: John P. Ary
Permittee Company: Fremont Paving& Redi-Mix,
Inc.
Address: 839 MacKenzie Avenue
P.O. Box 841
Canon City,CO 81215
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Jodi Schreiber
Company: Fremont Paving&Redi-Mix Inc
Address: 839 Mackenzie Ave
P.O. Box 841
Canon City,CO 81215
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Inspection Contact: Jodi Schreiber
Company: Fremont Paving&Redi-Mix Inc
Address: 839 Mackenzie Ave
P.O. Box 841
Canon City, CO 81215
Phone Number: [phone] ✓
Fax Number: [phone]
Email Address: [e-mail]
I,the undersigned,hereby state that the information provided in this report is true and accurate, and that site operations are
bein nducted in acco ance with the Divisio proved mining and reclamation plans.
04.L' - Ej 0
Signat*V of Pe ttee Cor r,Owner,or Documented Desienee Date
M-AF-01