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.:. <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNPJERSARX DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~~~~ <br />Ready Mixed Concrete Company`rYtT'r'i . <br />s~M-1996-052 <br />Del Camino Sand and Gravel Mine <br />Augast 4, 2005 <br />kls <br />~UG 0 3 2005 <br />~aiviaion d t+tinarcis & GaaioAY <br />$688.00 (Due on or before your anniversary date) <br />Weld <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 feel a report and map showing the extern of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding yeaz, new disturbances that aze anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the beginning <br />of active operations, and the date active operations ceased for the yeaz, if any. <br />Please attach xpur revised written annnal tenor[ and annnal report m ~ to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact; Bill Timmons <br />Permittee Name: Ready Mixed Concrete Company <br />Address: 4395 Washington St. <br />Denver, GO 80216 <br />Phone Number: (303) <br />Fax Number: <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 aze enclosed. <br />'~ <br />Signatu a of Corporate Officer,lOwner, or Designee <br />~`, ~bo~ <br />Date I <br /> <br /> <br />