2017-08-15_REPORT - M1984101

• Permit No: M1984101
• IBM Index Class Name: REPORT
• Doc Date: 8/15/2017
• Doc Name: Annual Fee/Report/Map
• From: Hard Rock Paving and Redi-Mix, Inc.
• To: DRMS
• Annual Report Year: 2017
• Email Name: MAC
• 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: Hard Rock Paving and Redi-
Mix, Inc.
Address: P.O. Box 841
Canon City,CO 81215
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Jodi Schreiber
Company: Hard Rock Paving&Redi Mix,
Inc.
Address: P.O. Box 841
Canon City, CO 81215-0841
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: Jodi Schreiber
Company: Hard Rock Paving&Redi Mix,
Inc.
Address: P.O. Box 841
Canon City, CO 81215-0841
Phone Number: [phone]
Fax Number:
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
being ducted in ac ' ;ance with the Division approved mining and reclamation plans.
Signa 'e of Per •, u'orat• i ' icer,Owner,or Documented Designee Date
M-AF-01