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<br /> RECEIVED <br /> ANNIlAi, FF,F, and RF.PnRT RF.nitF.CT JAN 1 5 <br /> 2003 <br /> <br />PERMITTEE NAME: <br />Mathias Concrete, Inc. Division of Minerals and Geology <br />PERMIT NO.: M-1977-140 <br />OPERATION NAME: N Farm Rd Pit No 1 <br />ANNNERSARY DATE: January 15, 2003 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date ` <br />COUNTY: Rio Grande <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, 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_yeac.new_disturbances_that_are_anticigated_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 y~nnr revised written anneal rennrt and anneal report man to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following pemtittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Thomas G. Mathias <br />Permittee Name: Mathias Concrete, Inc. j <br />Address: 1500 N. FatjhRd. +// <br />P.O. Box 266 <br />Phone Number: <br />Fax Number: <br />Monte Vista, CO 81144 <br />(719) 852-3732 <br />(719)852-3759 <br />~ ~~ <br />~/~ <br />~, o~ <br />S <br />~S <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 repoR and map. Annual Report instructions are enclosed. <br />..~1°S <br />Signature of Corporate Office ,Owner, or Designee <br />Dat~ <br />M:~PERMnVv1ASTERD000MENT5UI-AF-01 <br />