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ANNTiAi, FF.F, and REPORT RF.(1TiF.CT c <br />RC CE~ ~E~ <br />PERMITTEE NAME: Valco Canon City Concrete Div. <br />PERMIT NO.: M-1977-559 DEB 13 ?005 <br />OPERATION NAME: Canon City East Pit Division~fMineralsand <br /> Gppfpy~ <br />ANNIVERSARY DATE: February 22, 2005 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <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 />-occurdurircg-ilte-upeomirg year,-reclamation-thatwill. he performed-during_the_coming year, the dates far the_ _ _ _ __ <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written anmial re~nrt and annual re op rt maTn 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: Randy Symons <br />Permittee Name: Valco Canon City Concrete Div. <br />Address: 730 S. Mackenzie <br />P.O. Box 669 <br />Canon City, CO 81215-0669 <br />Phone Number: (719) 275-7441 <br />Fax Number: (719) 275-7470 <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 />,Owner, or Designee <br />l <br />Date <br />MiPERMIINIASTERDOCUMENT5UI-AF-04 <br />