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- - • III IIIIIIIIIIIIIIII � � z�4`�S � ��� <br /> 999 RECEIVED <br /> ANNUAL FEE and REPORT REQUEST NOV 2 4 20M <br /> Division of Minerals and Geology <br /> PERMIT-FEE NAME: Southwest Ready-Mix, Inc. <br /> PERMIT NO.: Ag-198Sd•195 + <br /> OPERATION NAME: Alamosa Pit No.2 <br /> ANNIVERSARY DATE: November 25,2000 <br /> ANNUAL FEE DUE: $688.00(Due on or before your anniversary date) <br /> COUNTY: Alamosa <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 <br /> operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br /> land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br /> occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br /> beginning 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 man to this form. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br /> report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: Kris DeGolyer <br /> Permittee Name: Southwest Ready-Mix, Inc. <br /> Address: 117 White Pine Dr. <br /> Alamosa, CO 81101 <br /> Phone Number: (719) 589-5103 <br /> Fax Number: (719) 589-5522 <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 <br /> enclosed. <br /> Signature of Corporate Officer or�Oierl <br /> /Z _ /7 " oa <br /> Date <br /> I <br /> M TERMITMASTERDOCUMENTSW AF-01 <br />