2017-12-20_REPORT - M1982155

• Permit No: M1982155
• IBM Index Class Name: REPORT
• Doc Date: 12/20/2017
• Doc Name: Annual Fee/Report/Map
• From: Schmidt Construction Co.
• 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: Scott Davis
Permittee Company: Schmidt Construction Company
Address: 2635 Delta Dr. — -
Colorado Springs,CO 8091 o
Phone Number: [phone]
Fax Number: [phone]
Email Address. SDAVIS�a�-schmidtconstr.com
Permitting Contact: Bill Schenderlein Scott Davis
Company: Blue Earth Schmidt Construction Company
Address: P.O. Box 973 2635 Delta Drive
Fort Collins,CO 80522 Colorado Springs, CO 80910
Phone Number: [phone] [phone]
Fax Number:
[phone]
Email Address:
SDAVIS@ schmidtconstr.t;om
Inspection Contact: Dan Chavez
Company: Schmidt Construction Company
Address: 900 S.Charter Oak Ranch Road
Fountain,CO $0817
Phone Number: [phone]
Fax Number:
Email Address:
1, the undersigned, hereby state that the information provided in this report is true and accurate,and that site operations are
bein conducted in accordance with the Division approved mining and reclamation plans.
r ��'
Signature of Pe rmitt C r ora e O icer,�,or Documented Designee { Date
M-AF-01