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_ - - sss <br />ANNUAL REPORT <br />PERMITTEE NAME: Mathias Concrete, Inc. <br />PERMIT NO.: M-1980-201 <br />OPERATION NAME: O'Bannon Pit <br />ANNNERSARY DATE: October 23, 2000 <br />ANNUAL FEE DUE ON ANNNERSARY DATE: $688.00 <br />COUNTY: Rio Grande <br />~ ~ ~~~ ~° <br />C.~ ~ 33q a. <br />RECEIVED <br />ocr ~ s zooo <br />din:inn et Mlnerale end GeoloAY <br />According to C.R.S. 34-32-116(3)(a), each yeaz, on the anniversary date of the permit, an operator shall <br />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 aze anticipated <br />to occur during the upcoming year, reclamation that will be performed during the coming yeaz, the <br />dates for the beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised annual resort mau and written resort to this annual report. Please <br />note that an adequately labeled map that clearly delineates and includes the above elements may <br />suffice for a written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the space <br />provided: // 1 <br />Contact Name: /© ~/.Z7Tir t~s Company: /,~f/.c (a r rim t.~a ,-L,,, c _ <br />Address: ~~ 1( ,~//r, Phone No.: (7~9) ~~.,?- 3'7~ z <br /> <br />e-mail: <br />If [here are additional comments and/or information that should be provided to the Division, please <br />provide it on a sepazate sheet and attach it to this report form along with your map and/or written <br />report. <br />/~-~~-Q~ <br />Signature of Corporate Offic , or Owner Date <br />INSTRUCT/ONS ON BACK <br />• <br />MIPERM rM7A5TERD000MENTSU7~AF~01 <br />