2017-11-17_REPORT - M1977168

• Permit No: M1977168
• IBM Index Class Name: Report
• Doc Date: 11/17/2017
• Doc Name: Annual Fee/Report/Map
• From: Colorado Quarries 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:
Bill Tezak
Permittee Company:
Colorado Quarries Inc
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 l5th 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:
1, the undersigned, hereby skate that the information provided in this report is true and accurate, and that site operations are
being conducted in accofdan a with the Division approved mining and reclamation plans.
Owner, or Documented Designee Date