2018-06-11_REPORT - M1987116

• Permit No: M1987116
• IBM Index Class Name: REPORT
• Doc Date: 6/11/2018
• Doc Name: Returned Annual Fee/Report
• From: DRMS
• To: Bill Tezak
• Annual Report Year: 2018
• 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: -Kettnettr 10e P
Company: Colorado Quarries Inc
Address: 270 S 15th St
Canon City,CO 81212
Phone Number: [phone]
Fax Number: -7
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,h state that the information provided in this report is true and accurate,and that site operations are
being conducted in ccorc(ance with the Division approved mining and reclamation plans.
gnatur of Per itt Co orate Officer Owner,or Documented Designee Date
M-AF-01