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+ � • III IIIIIIIIIIIIIIII �•It 37G ''°� <br /> sss <br /> ANNUAL FEE and REPORT REQUEST <br /> PERMITTEE NAME: Centennial Materials, Inc. RECEIVED <br /> PERMIT NO.: M-1982-155 DEC 2 12000 <br /> OPERATION NAME: Fountain Pit Division of Minerals and Geology <br /> ANNIVERSARY DATE: December 31,2000 <br /> ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br /> COUNTY: El Paso <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 <br /> operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br /> land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br /> occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br /> beginning of active operations, and the date active operations ceased for the year, if any. <br /> Please attach your revised written annual report and annual report map to this form. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br /> report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: Scott Davis <br /> Permittee Name: Centennial Materials, Inc. <br /> Address: 2635 Delta Dr. <br /> Colorado Springs, CO 80910 <br /> Phone Number: (719) 392-4207 <br /> Fax Number: (719) 392-4245 <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 <br /> enclosed. <br /> Sigt�If Corporate Office rot Owner <br /> 1'2-(3 -yo <br /> Date <br /> M TERMITWASTERDOCUMENTSN-AF-01 <br />