2010-09-30_REVISION - M1977053

• Permit No: M1977053
• IBM Index Class Name: REVISION
• Doc Date: 9/30/2010
• Doc Name: Constr Materials Reg 112 Operation Reclamation Permit Application Form
• From: Asphalt Constructors, Inc.
• To: DRMS
• Type & Sequence: AM2
• Email Name: WHE
• Media Type: D
• Archive: No

-3-
11. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Contact's Name: Todd A. Stockebrand
Company Name: Asphalt Constructors, Inc.

Street/P.O. Box: 7040 W. US Highway 160
City: Alamosa

State: Colorado
Telephone Number: (719 1- 589-6671
Fax Number: (719 ) - 589-0927
PERMITTING CONTACT (if different from applicant/operator above)
Contact's Name: Tiffany Hawkins
Company Name: Asphalt Constructors, Inc.

Street/P.O. Box: 7040 W. US Highway 160
City: Alamosa

State: Colorado
Telephone Number: (719 589-6671
Fax Number: (719 1. 589-0927
INSPECTION CONTACT
Contact's Name: Todd A. Stockebrand
Company Name: Asphalt Constructors, Inc.

Street/P.O. Box: 7040 W. US Highway 160
City: Alamosa

State: Colorado
Telephone Number: (719 589-6671
Fax Number: (719 1 589-0927
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:

Street:

City:

State:

Telephone Number: ( 1-
CC: STATE OR FEDERAL LANDOWNER (if any)
Agency:

Street:

City:

State:

Telephone Number: ( ) -
Title: President
P.O. Box:
Zip Code: 81101
Title: Executive Assistant
P.O. Box:
Zip Code: 81101
Title: President
P.O. Box:
Zip Code: 81101
Zip Code:
Zip Code: