2017-11-17_REPORT - M1987027

• Permit No: M1987027
• IBM Index Class Name: Report
• Doc Date: 11/17/2017
• Doc Name: Annual Fee/Report/Map
• Annual Report Year: 2017
• Email Name: TC1
• Media Type: D
• Archive: No

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Division records indicate the followingpermitteellandowner 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 rnfor
TerTnittee-Conlan $r-11 TCY
i 7amcan a icompau -
lydomdo terries I=
Address:
270 S 15th St
Canon City, CO 81212
Phone Number:
[phone]
Fax Number:
[phone]
Email Address:
[e-mail]
Permitting Contact:
Bill Tezak
Company: "'
Colorado Quarries Inc
Address:
270 S 15th St
Canon City, CO 81212
Phone Number:
[phone]
Fax Number:
----------------- - - - --- ----------------- --
Email Address:
Inspection Contact:
Bill Tezak
Company:
Colorado Quarries Inc
Address:
270 S 15th St
Canon City, CO 81212
Phone Number:
[phone]
Fax Number:
Email Address:
I, the undersigned, hereby sta at the information provided in this report is true and accurate, and that site operations are
being conducted in accorda a --lith the Division approved mining and reclamation plans.
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Si ur of Permi tee C ate Officer, Owner, or Documented Designee Date
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