2017-11-20_REPORT - M1977193

• Permit No: M1977193
• IBM Index Class Name: REPORT
• Doc Date: 11/20/2017
• Doc Name: Annual Fee/Report/Map
• From: Tezak Heavy Equipment Co. Inc.
• To: DRMS
• Annual Report Year: 2017
• Email Name: TC1
• Media Type: D
• Archive: No

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Division records indicate the following permitteeilandowner 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: Randy DiLuzio
Permittee Company: Tezak Heavy Equipment Co. Inc.
Address: 205 Tunnel Dr.
Canon City, CO 81212
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Kenneth S.Klco
Randy DiLuzio
Company: Azurite, Inc.
Tezak Heavy Equiptient
Address: 10001 CR 12
P.O. Box 338 205 Tunnel Drive
Cotopaxi, CO 81223 Canon City, CO 81212
Phone Number: [phone]
719-269-1173
Fax Number: [phone]
719-269-1148
Email Address:
rdiluzio@tezakheavyequigi>ent.ccm
Inspection Contact: Randy DiLuzio
Company: Tezak Heavy Equipment Co. Inc.
Address: 205 Tunnel Drive
Canon City, CO 81212
Phone Number: [phone]
Fax Number: [phone]
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 conducte ' accorda with the D.,isi'n approved mining and reclamation plans.
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Signat e o ermittee orporate 0 /r,Owner,or Documented Designee to
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