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<br />~~I II~I~~II~I~~~ ~~~ l {~T <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: L & L Ready Mix RECEIVE D <br />PERMIT NO.: M-1993-066 JAN 2 3 2002 <br />OPERATION NAME: Barkey Pit <br />Division of Minerals and Geology <br />ANNIVERSARY DATE: January 12, 2002 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Phillips <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-1 l6, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual resort map to this form. Plense more that arr <br />adequately labeled rnnp [hat clearly delineates mtd Includes the above elements pray suffice for a written report. <br />Division records indicate the following permit[ee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Laurine Koellner <br />Permittee Name: L & L Ready Mix <br />Address: P.O. Box 218 <br />Phone Number: <br />Haxtun, CO 80731 <br />(970)774-6114 <br />Fax Number: <br />(970)774-6114 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer or Owner <br />f- I L-OZ <br />Date <br />M. W E R M rf Vv1 A ST E R D OC U M E NTSUt -A F-01 <br />OuR /°jr ~S la~~C~i£tr ~F«irrF~J, <br />~2fSF.fJrfD /I~vO G/1ard7ti /S w~« <br />~/ydTOJ . GCJ~ ~'e~ /~r~'~~' T~ <br />CCd-f F our THiJ PiT G~[~h' <br />~~u2 U/ Fil £. ~.C. <br />~fC df q/o2 S &vna,r rv <br />p~~/ UJ~ <br />