2017-12-20_REPORT - M1976009HR

• Permit No: M1976009HR
• 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 80910
Phone Number: [phone]
Fax Number: (719)3924245
Email Address: [e-mail]
Permitting Contact: Scott Davis
Company: Schmidt Construction Company
Address: 2635 Delta Dr.
Colorado Springs, CO 80910
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: Scott Davis
Company: Schmidt Construction Company
Address: 2635 Delta Dr.
Colorado Springs, CO 80910
Phone Number: [phone]
Fax Number:
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 conducted in accordance with the Division approved mining and reclamation plans.
I M &Zoo,, j J
wr _
Signature of Permittee,Cort3orate Officer,Owner,or Documented Designee Date
M-AF-01