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<br />- ~ ~11k~ <br />PiOi/ 2 t 2004 <br />^ivisia cf Gi :~ra1s g e~-:'c <br />V1/ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Southwest Ready-Mix, Inc. <br />M-1983-175 <br />Alamosa Pit No. 2 <br />November 25, 2004 <br />$688.00 (Due on or before your anniversary date) <br />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 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 precedixigyear,'new-disfurbances~haf aie ariticipafed to`occu? <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 Xgnr revised written annual re~tnrt and annual rennrt mgp to this form. Please note that an <br />adequately labeled map that clearly delineates 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: <br />Permittee Contact: Ralph Martinez <br />Perenittee 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) 584-5522 <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 enclosed. <br />~~~ <br />Signature of Corporate Officer, Owner, or Designee <br />-//~.~Z-l oy <br />Date <br />