2017-05-31_REPORT - M1987131

• Permit No: M1987131
• 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: 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: John P.Ary
Permittee Company: Fremont Paving&Redi-Mik,
Inc.
Address: 839 MacKenzie Avenue
Canon City, CO 81212
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Permitting Contact: Jodi P. Schreiber
Company: Fremont Paving&Redi-Mix,
Inc
Address: 839 MacKenzie Ave
Canon City, CO 81212
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: Jodi P. Schreiber
Company: Fremont Paving&Redi-Mix,
Inc
Address: 839 MacKenzie Ave
Canon City, CO 81212
Phone Number: [phone]
all S — 3AlA �
Fax Number:
Email Address: [e-mail]
1,the Adersigned, hereb tate that the information provided in this report is true and accurate, and that site operations are
bein c du ed i acco da ce with the Division approved mining and reclamation plans.
17
Signa re of Permittee Cor ora Officer ner,or Documented Designee Date
M-AF-01