2001-04-20_REPORT - M1983067

• Permit No: M1983067
• IBM Index Class Name: Report
• Doc Date: 4/20/2001
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
M-1983-067
APR 2 0 2001
g d peolo9Y
April 20, 2001 pivision of Mjp°rals an
$688.00 (Due on or before your anniversary date)
Adams
Sta ecoach Pit
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 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 the upcoming year, reclamation that 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 your revised written annual report and annual report maa to this form. Please Wore tltar an
adequately labeled map that c/early delrr:eates and ir:cludes the above elements may sujfrce jor a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Eric Recken[ine
Permittee Name: Mobile Premix Concrete, Inc.
Address: 1590 W. 12th Ave.
Denver. CO 80204
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
Signature of Corporate Officer or Owner
~`~/~~o/
Dat~
• • III IIIIIIIIIIIIIIII
999
ANNUAL FEE and REPORT REQUEST
Mobile Premix Concrete, Inc. RECE~V ~D
M:~PERM I"IlA1P.STERDOC UMENTSV.I-AF-0 I