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~II II~II~~II~~~~ II~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Transit Mix Concrete <br />M-1973-007-SG <br />Daniels Sand Pit 2 <br />January 7, 2002 <br />RECEIVED <br />JAN 0 7 2002 <br />IliYislon o1 Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />EI Paso <br /> <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on [he 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 disturbances 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 vour revised written annual report and annual report map to this form. Pleose Mole tha! art <br />adequately labeled map that clearly delrneares 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: 1 f'' <br />Permittee Contact: Ger rmans ~ ~ V\\Q• <br />Permittee Name: Transit Mix Concrete <br />Address: 4~44~E. Costill~a <br />r iii.~-~v ~t <br />Colorado Springs, CO 8~9~1-1030 ~~ a Y/ <br />Phone Number: (719) 475-0700 q <br />Fax Number: (71 ~ l ~~,'~_~~ <br />If you have additional cornments 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 />. V <br />Sid atu f Corporate Officer or Owner <br />~ ~>n ~1, ~.oa~. <br />Date <br />M ~PERMrIN1ASTERD(KUMENTSVN AF-01 <br />