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b? <br />PfiR.MrrrEE NAME' <br />PF..RMri NO.: <br />OPERA =ION NAM& <br />/,WNrNMRSAR.Y DAIS <br />ANNUAL FEE DUE' <br />COMM <br />�c <br />AYl 11At- M and REPORT RMiMT <br />l2lEC3h c y 's Red£ Mit Concrete, Ina <br />144 -2005-870 <br />icrchaieyer Pit <br />3aa T 26,2014 <br />SSo'23.00 (Due an or- before your anaivarsary date) <br />Pbiiiigs <br />According to C.R.S. 34-332-5-1 16 or GRS. 34 -32 -1 I5, each year, on the am'ive-my date of the pe:mis, as ogeMo: <br />shall submit the annual fee, a report and map showing the 'ascent of current disturbances to affected lanes, <br />:e tamatioht accomplished to date and during the ptrccding yearn tte�v disturbances that am anticipated to pour <br />during the upcoming year, reclamation chat wilt be performed during the coming year. due dates for the beginning <br />of =6v2 opnrattons, and the date sctivc opza2ions ceased for the year, if any. <br />P gip, Vogt acxiscd .� rte -:stt aaAasi rc aM and aanaot retort n P to this forte Cite Aaueaf Report <br />fi Fee r2gt4r==t is not met unit we h wo receivedd the falto%ving compaaeuts fep_ re stud associated <br />. T no new distarlr�aees or :crlamtti tea itava_occurrcti during the Previous vear and as new chau2as to <br />tine areYtettis tear's man are ap"^eeary tt3en no ueiv azau is rebutted Provided that tite Ommtrator shalt slate <br />bN ipt the Auga Bettor t. Plecse note rFar mt adequately labeled map that clearly delrncares and unC« rJW <br />above 2140 me►hrs mm� sufj%e for a uTitren reperi. <br />Divisiem records indicate the following Fernhittee Contact information. Please verify and Make any necessary <br />changes: <br />permitter Centact. JMry Ititahcy <br />r <br />' <br />. L ' <br />Pe rrittestiasttc: Ritcltoy's Reds -Mix Concrete. Inc. / <br />Address: 509 S Idiewild St j <br />Yum*, CO Sri S9 ' <br />PhoneNt mbzr. (970)849-5451 i <br />Fax wumber. (970) 84;-5453 -- <br />If you have add tiontU comments atuilor information that should be providrd to the Divistor., please provide it <br />below o: attach is het this form along with your %vriren reparr and map. Anmmi Report instructions are enclosed. <br />5t�tatu � <br />ec : oO= ecer. / i r, oi� <br />01 -22 -2014 <br />Dais <br />I <br />