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~h~- <br />ANNiJAi. FF.F, and RF,P(1RT RF.OiJFST ~` "` ""~" <br />C;-:~an of ~'~iaarols f: Gr.~.c;;y <br />PERMITTEE NAME: Loveland Ready Mix Concrete, Inc. <br />PERMIT NO.: M-2001-022 <br />OPERATION NAME: Green/Croissant Property Sand and Gravel Mine <br />ANNNERSARY DATE: January 16, 2005 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Weld <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />__ shall submit the annual f_ee,. a report_and map showing the extent_ of current_ dsturbances_ to affected_land, _ __ _ <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annnal rennN and annual re n~ rt man to Chic fnrm_ Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Steve Fancher <br />Permittee Name: Loveland Ready Mix Concrete, Inc. <br />Address: P.O. Box 299 <br />Loveland, CO 80539 <br />Phone Number: (970) 667-2680 <br />Fax Number: {970) 667-0036 <br />If you have additional comments and/or information that should be provided to the Division, please provide <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />~~<r~-~'~ Secretary <br />$~nature of Corporate Officer, Owner, or Designee <br />Date <br />