2004-09-30_REVISION - M1988093

• Permit No: M1988093
• IBM Index Class Name: Revision
• Doc Date: 9/30/2004
• Doc Name: Amendment Application
• From: Fremont Paving & Redi Mix Inc
• To: DMG
• Type & Sequence: AM1
• Media Type: D
• Archive: No

-3-
14. Cotresoondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: John P. Ary Title: Sec./Treas.
Company Name: Fremont Paving &Redi Mix, Inc.
Street/P.O.Box: 839 Mackenzie Ave. P.O.Box: 841
City: Canon City
Stale: Colorado Zip Code: 81212
Telephone Number ( 719 )_ 275-3264
Fax Number: ( 719 )_ 275-8897
PERMITTING CONTACT (if different from applicantlopera[or above)
Contact's Name: Denise Gonzales Title: Compliance Supervisor
Company Name: Fremont Paving &Redi Mix, Inc.
Street/P.O.Box: 839 Mackenzie Ave. P.O.Box: 841
City: Canon City

State: Colorado Zip Code:
Telephone Number: ( 719 )- 275-3264
Fax Number. ( 719 )_ 275-8897

INSPECTION CONTACT
Contad's Name: Title:

Company Name:

Street/P.O. Box: P.O. Box:

City:

Stale: Zip Code:

Telephone Number: ( ) -

Fax Number: ( 1-

CC: STATE OR FEDERAL LANDOWNER (if any
Agency:

Street:
City:
S[a[e:
Telephone Number: ( ) -
CC: STATE OR FEDERAL LANDOWNER (if anv)
Agency:
Street:
City:
State:
Telephone Number
Zip Code:
Zip Code: