2017-06-29_REPORT - M2005066

• Permit No: M2005066
• IBM Index Class Name: Report
• Doc Date: 6/29/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Asphalt Paving Company
• Annual Report Year: 2017
• 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:

Mark Martin
Permittee Company:

Asphalt Paving Company
Address:

14802 W 44th Ave
Golden, CO 89403

Phone Number:

[phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact:

Paul Banks
Company:

Banks and Gesso, LLC
Address:

720 Kipling Street, Suite 117
Lakewood, CO 80215

Phone Number:

[phone]
Fax Number: [phone]
Email Address:
Inspection Contact:

Jeff Keller
Company:

Asphalt Paving Company
Address:

14802 W 44th Ave
Golden, CO 89403

Phone Number:

[phone]
Fax Number: [phone]
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.

Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date
M-AF-01