2017-11-24_REPORT - M2004020

• Permit No: M2004020
• IBM Index Class Name: REPORT
• Doc Date: 11/24/2017
• Doc Name: Annual Fee/Report/Map
• From: M.A. Concrete Construction, Inc.
• To: DRMS
• Annual Report Year: 2017
• Email Name: SJM
• Media Type: D
• Archive: No

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Inc.Address: 2323 River Road
Grand Junction, CO 81505
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Martin Azcarraga
Company: M.A. Concrete Construction,
Inc.
Address: 2323 River Rd.
Grand Junction, CO 81505
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Inspection Contact: Martin Azcarraga
Company: M.A. Concrete Construction,
Inc.
Address: 2323 River Rd.
Grand Junction, CO 81505
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
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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.
L447 ' / 7
Signature of Pier ittt e,Corporate Officer,Owner,or Documented Designee D to
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