REP06615

• Permit No: M1978052
• IBM Index Class Name: Report
• Doc Date: 3/4/2002
• Doc Name: 2002 Annual Report
• From: Mobile Premix Inc.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
-~-
ANNUAL FEE and REPORT REQUEST
Mobile Premix, Inc.
M-1978-052
Howe Pit
February 15,2002
RECEIVEp
MAR 0 41002
Division of Minerals and Geology
$550.00 (Due on or before your anniversary date)
Adams
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an operator
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during [he upcoming year, reclamation [hat will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach vour revised written annual report and annual report map to this form. Plense note thnt nn
udcy~eatel~~ labeled nu~p rhea clean}' rleltiteutas mul urcludes il~e uborc eleineats nta}~ a ff rce~or « n~r~nea report.
Division records indicate [he following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Eric Reckentine
_. , . Permittee Name: Mobile Pidmix, Inc.
Address: 1590 W. 12th Ave.
Denver, CO 80204
Phone Number: (303) 657-433>l)
Fax Number. [phone]
If you have additional comments and/or information that should be provided to [he Division, please provide it
below or attach it to this form along with your written report and map. Annual Repot[ instructions are enclosed.
Signature of Corporate Officer or Owner
~~A/~ Z
Date
M iPERM IT~MASTERDOCUM ENTSN7-AP-01