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RECEIVED <br />NOV 1 2 2002 <br /> <br />ANNUAL FEE and REPORT REQUEST <br />Uiuision of Minerals and Geology <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Transit Mix of Pueblo, Inc. <br />M-1986-015 <br />Pueblo East Pit <br />November 12, 2002 <br />$688.00 (Due on or before your anniversary date) <br />Pueblo <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 year, new disturbancec_that_are-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 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 saffece for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Mark Klune <br />Permittee Name: Transit Mix of Pueblo, Inc. <br />Address: 5475 Hwy. 96 W. <br />P.O. Box 857 <br />Phone Number: <br />Fax Number: <br />Pueblo, CO 81002 <br />(719)561-8350 <br />(719)566-0231 <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 enclosed. <br />~~ <br />Sig afore of Corporate Officer, Owner, or Designee <br />~o ~d-aooa <br />Date <br />M:~PERMmMASTERD000M EMS~ht-AF-O] <br />