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/~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNTIAT, FF,F. and RF,PnRT RF.OiTFRT <br />Wyatt Redi-Mix Co ~~ <br />~I11-1997-039 <br />Williamslillinois Gravel Pit <br />August 12, 2005 <br />RECEtI/F~ <br />,~ ~L i g ~ <br />" Uiregan of toms,,,.. ,. - <br />$281.00 (Due on or before your anniversary date) <br />Jackson <br />~ r' <br />According to C.R.S. 34-32.5-1 lb or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />sfiat[ subm-" i[-Elie an e , a < < canent-distnrtrmces-to'affecte$-land, - <br />reclamation accomplished to date and during the preceding year, new disturbances that sire 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 ynnr revised written annnal report and annnal re r~~ t man n this fnrny 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: Richard F. Wyatt <br />Permittee Name: Wyatt Redi-Mix Co <br />Address: P.O. Box 1052 <br />Phone Number: <br />Fax Number: <br />Walden, CO 80480 <br />(970)723-4471 <br />(970) 723-3222 <br />If you have additional comments and/or information that should be <br />below or attach it to this form along with your written report and map. <br />GJy~JT ~sY/-~~k is STILL /y STS / a,f' <br />P d", ~~~~ <br />Si afore of Corporate O cer, Owner, or Designee <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed. <br />rsr~ D?~~i.~~ g- ~.~+tftp~.9j~B ~7 <br />,~/~los' <br />Date <br />